Neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker for Dengue severity: A systematic review and meta analysis | ||
| Microbes and Infectious Diseases | ||
| Articles in Press, Accepted Manuscript, Available Online from 17 October 2025 | ||
| Document Type: Systematic review or meta-analysis | ||
| DOI: 10.21608/mid.2025.402866.3011 | ||
| Authors | ||
| M. Salas Al Aldi* 1; Aisyah Nurul Salsabila Azuz1; Veronica Gosari1; Nur Indah Asni Puspita Dewi1; Sitti Wahyuni2 | ||
| 1Faculty of Medicine, Hasanuddin University, Jl. Perintis Kemerdekaan No.KM.10, Tamalanrea Indah, Tamalanrea District, Makassar City, South Sulawesi 90245, Indonesia | ||
| 2Department of Parasitology, Faculty of Medicine, Hasanuddin University, , Jl. Perintis Kemerdekaan No.KM.10, Tamalanrea Indah, Tamalanrea District, Makassar City, South Sulawesi 90245, Indonesia | ||
| Abstract | ||
| Background: Dengue fever, a viral infection transmitted by Aedes mosquitoes, manifests in a spectrum of clinical presentations, ranging from mild to severe disease. The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, has been investigated as a potential prognostic indicator for dengue severity. However, its predictive value remains inconclusive due to inconsistent evidence. Methods: This systematic review and meta-analysis adhered to the PRISMA guidelines. Relevant observational studies were retrieved from ScienceDirect, Web of Science, Scopus, NCBI PubMed, ProQuest, and EBSCO databases. Studies reporting NLR values and their association with dengue severity were included. Quality assessment was performed using the Newcastle-Ottawa Scale, and data analysis employed a random-effects model to address heterogeneity. Results: A total of nine studies involving 3,289 participants were included. Findings regarding the relationship between NLR and dengue severity were inconsistent. The results of this meta-analysis highlight a significant correlation between a higher NLR and the severity of dengue fever (OR 2.74 (95% CI: 1.97, 3.81)). Conclusions: The NLR demonstrates potential as a simple and cost-effective inflammatory marker; however, its prognostic utility in dengue severity remains limited. The overall meta-analysis suggests a significant correlation between elevated NLR and increased severity of dengue infection. However, NLR should be considered alongside other clinical indicators to provide a more comprehensive assessment of dengue severity. Future research with larger and more homogeneous sample sizes is necessary to further validate these findings and explore the underlying mechanisms linking NLR to disease progression. | ||
| Keywords | ||
| Dengue fever; neutrophil-to-lymphocyte ratio (NLR); prognosis; severity | ||
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