Neutrophil-to-lymphocyte ratio as a diagnostic marker: A comparative study in dengue and malaria patients
DOI:
https://doi.org/10.55629/pakjpathol.v36i4.953Abstract
Objective: To evaluate the diagnostic utility of neutrophil-to-lymphocyte ratio in distinguishing dengue from malaria and its association with thrombocytopenia.
Material and Methods: A prospective cross-sectional study was conducted at Creek General Hospital Laboratory from1st June to 31st August 2025,including105 confirmed cases of dengue (n = 50) and malaria (n = 55). Hematological indices, including platelet count and neutrophil-to- lymphocyte ratio, were assessed. Statistical analysis was performed using SPSS version 26. Mann– Whitney U test and Fisher’s exact tests, with significance set at p < 0.05.
Results: Majority (50.5%) of patients were young adults, 16–30 years with male predominance (61%). Thrombocytopenia was present in both groups, with severe thrombocytopenia in 48% of dengue and 36.4% of malaria cases, showing no significant association with infection type (p = 0.242). Neutrophil-to-lymphocyte ratio differed significantly between malaria and dengue cases. Malaria patients had a higher mean value (5.43 ± 4.56; median 3.45, IQR 1.16–6.22) compared to dengue patients (2.72± 2.52; median 2.02, IQR 1.30–3.38) (p < 0.001). High neutrophil-to-lymphocyte ratio was more frequent in malaria (58.2%), low ratio predominated in dengue (84%) and p < 0.001.
Conclusion: Platelet count alone cannot reliably differentiate dengue from malaria, neutrophil-to- lymphocyte ratio provides strong discriminatory value. Elevated ratio is associated with malaria, and low ratio with dengue, making it a simple, cost-effective diagnostic and prognostic marker in resource-limited endemic settings.
Keywords: Dengue, Diagnostic marker, Malaria, Neutrophil-to-Lymphocyte ratio, Thrombocytopenia
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