Role of neutrophil–lymphocyte ratio in the management of children with snake bite envenomation: A single-center prospective observational study

Neutrophil–lymphocyte ratio (NLR) has recently gained popularity as a simple, inexpensive, and highly accurate inflammatory marker. When the differential count of leukocytes is checked following it is characterized by leukocytosis with an increase in neutrophil count and a decline in lymphocyte counts. This study was conducted to assess whether alteration in the differential count of leukocytes following envenomation has the ability to diagnose and predict the severity and prognosis in children and to derive a cutoff value for the same. This prospective observational study was done in the pediatric intensive care unit (ICU) of a tertiary care hospital from July 2019 to June 2020. From the complete blood count of patients done at admission, NLR1 was calculated. All patients were treated as per the national snake bite treatment protocol. The amount of antisnake venom (ASV) given, duration of hospital stay, and ICU stay were correlated with NLR1 values. An NLR value of 3.35 can predict envenomation with 95% sensitivity and 100% specificity. Similarly, an NLR value of 6.72 can predict the need for more than 10 ASV vials with a sensitivity of 93% and specificity of 97%, and an NLR value of 6.72 can predict the occurrence of major complications with a sensitivity of 89.3% and specificity of 94%. NLR can differentiate poisonous snake bites from nonpoisonous bites and can also predict the severity of the envenomation.