The Relationship Between Leukocytosis and Lymphopenia and the Clinical Outcome of Pneumonia in Toddlers Aged 12-59 Months
Abstract
Pneumonia is an acute infection of the lung parenchyma that commonly affects children under five years of age and remains a leading cause of pediatric morbidity and mortality worldwide. The inflammatory response to pneumonia is accompanied by alterations in hematological parameters, including leukocytosis and lymphopenia, which may reflect disease severity. This study aimed to evaluate the association between leukocyte and lymphocyte counts and clinical outcomes in toddlers hospitalized with pneumonia at Budhi Asih Regional Hospital. This observational analytical study employed a cross-sectional design using medical records of 117 toddlers diagnosed with pneumonia. Leukocytosis was defined as a leukocyte count of >15,500 cells/µL, while lymphopenia was defined as a lymphocyte count of <2,000 cells/µL. Clinical outcomes were categorized as improvement or deterioration. Associations between hematological parameters and clinical outcomes were analyzed using the Chi-square test, and effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Leukocytosis was significantly associated with clinical deterioration (OR = 24.27, 95% CI: 6.97–84.52; p < 0.001). Likewise, lymphopenia was significantly associated with unfavorable clinical outcomes (OR = 3.05, 95% CI: 1.13–8.26; p = 0.024). A significant association was also observed between leukocyte and lymphocyte abnormalities (p = 0.004). Children with leukocytosis and lymphopenia were more likely to experience clinical deterioration than those without these hematological abnormalities. These findings suggest that leukocytosis and lymphopenia are significantly associated with clinical outcomes in toddlers with pneumonia and may serve as useful adjunctive laboratory markers in clinical assessment. However, because of the cross-sectional design, causal or prognostic inferences cannot be established. Prospective longitudinal studies are warranted to validate their predictive value for disease progression and clinical outcomes.
Keywords: Clinical outcomes, leukocytes, lymphocytes, toddler pneumonia
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Adbela, G., Abdurahman, H., Hailu, S., Keneni, M., Mohammed, A., & Weldegebreal, F. (2024). Treatment outcome of pneumonia and its associated factors among pediatric patients admitted to Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia. Frontiers in Pediatrics, 12, 1296193.
https://doi.org/10.3389/fped.2024.1296193
Alemu, W., Ademassu, M., Belayneh, F., Gebeyehu, Y., Zenebe, G. A., & Lerango, T. L. (2025). Predictors and time to poor management outcomes among pediatric patients hospitalized with pneumonia in the Gedeo Zone, southern Ethiopia: a prospective follow-up study. Frontiers in Pediatrics, 12, 1447363.
https://doi.org/10.3389/fped.2024.1447363
Anteneh, Z. A., Arega, H. E., & Mihretie, K. M. (2023). Validation of risk prediction for outcomes of severe community-acquired pneumonia among under-five children in Amhara region, Northwest Ethiopia. PLoS One, 18(2), e0281209.
https://doi.org/10.1371/journal.pone.0281209
Chen, Y., Miller, H., Benlagha, K., Byazrova, M., Filatov, A., Zhang, Z., Liu, L., Ding, Y., Yang, L., Gong, Q., & Liu, C. (2025). A Focus on the Mechanisms of Alteration in Host Lymphocyte Level Following Severe Fever with Thrombocytopenia Syndrome Virus (SFTSV) Infection. Journal of Inflammation Research,
https://doi.org/10.2147/JIR.S531068
Cilloniz, C., Peroni, H. J., Gabarrús, A., García-Vidal, C., Pericàs, J. M., Bermejo-Martin, J., & Torres, A. (2021). Lymphopenia is associated with poor outcomes of patients with community-acquired pneumonia and sepsis. 8(6). https://doi.org/10.1093/ofid/ofab169
Corica, B., Tartaglia, F., D’Amico, T., Romiti, G. F., & Cangemi, R. (2022). Sex and gender differences in community-acquired pneumonia. Internal and Emergency Medicine, 17(6), 1575–1588. https://doi.org/10.1007/s11739-022-02999-7
Dudognon, D., Levy, C., Chalumeau, M., Biscardi, S., Dommergues, M.-A., Dubos, F., Levieux, K., Aurel, M., Minodier, P., & Zenkhri, F. (2021). Diagnostic accuracy of routinely available biomarkers to predict bacteremia in children with community-acquired pneumonia: A Secondary analysis of the GPIP/ACTIV pneumonia study in France, 2009–2018. Frontiers in Pediatrics, 9, 684628.
Elçioğlu, Z., Errington, L., Metes, B., Sendama, W., Powell, J., Simpson, A., Rostron, A., & Hellyer, T. (2023). Pooled prevalence of lymphopenia in all-cause hospitalisations and association with infection: a systematic review and meta-analysis. BMC Infectious Diseases, 23(1), 848. https://doi.org/10.1186/s12879-023-08845-1
Hamilton, F., Arnold, D., & Payne, R. (2020). Association of prior lymphopenia with mortality in pneumonia: a cohort study in UK primary care. British Journal of General Practice. https://doi.org/10.3399/bjgp20X713981
Huang, G., Kovalic, A. J., & Graber, C. J. (2020). Prognostic value of leukocytosis and lymphopenia for coronavirus disease severity. Emerging Infectious Diseases, 26(8), 1839.
Jakhar, S. K., Pandey, M., Shah, D., Ramachandran, V. G., Saha, R., Gupta, N., & Gupta, P. (2018). Etiology and Risk Factors Determining Poor Outcome of Severe Pneumonia in Under–Five Children. The Indian Journal of Pediatrics, 85(1), 20–24. https://doi.org/10.1007/s12098-017-2514-y
Liu, L., Wenjie, X., Wang, Y., & Wang, X. (2025). Threshold effect of white blood cell count on the risk of refractory Mycoplasma pneumoniae pneumonia in pediatric patients: A retrospective cohort study. https://doi.org/10.1097/MD.0000000000044999
Lokida, D., Farida, H., Triasih, R., Mardian, Y., Kosasih, H., Naysilla, A. M., Budiman, A., Hayuningsih, C., Anam, M. S., & Wastoro, D. (2022). Epidemiology of community-acquired pneumonia among hospitalised children in Indonesia: a multicentre, prospective study. BMJ Open, 12(6), https://doi.org/10.1136/bmjopen-2021-057957
Mert, D., & Merdin, A. (2020). Prevalence of thrombocytosis, thrombocytopenia, lymphocytosis and lymphocytopenia in patients with lower respiratory tract infection and patients with urinary tract infection. Acta Clinica Croatica, 59(1.), 63–66. https://doi.org/10.20471/acc.2020.59.01.08
Pervin, S., Akhter, R., Farzana, N., & Khanom, T. (2024). Assessment of Inflammatory Markers (CBC and CRP) and their Impact on Severity and Recurrence of Pneumonia in Under-Five Children. Sch. J. App Med. Sci, 10, 1391–1396.
Prawidia, D., Zhafirah, L., Saputra, N., Kartiasih, F., & Sahu, U. (2023). Determinants of under-five mortality due to pneumonia: A negative binomial regression analysis. Jurnal Varian, 7(1), 59–66. https://doi.org/10.30812/varian.v7i1.2768
Purnama, T. B., Wagatsuma, K., & Saito, R. (2025). Prevalence and risk factors of acute respiratory infection and diarrhea among children under 5 years old in low-middle wealth household, Indonesia. Infectious Diseases of Poverty, 14(1), 13. https://doi.org/10.1186/s40249-025-01286-9
Putri, N. A., Buchari, B., Andayani, H., Murzalina, C., Yanti, B., & Saminan, S. (2023). Hubungan Kadar Limfosit Terhadap Derajad Keparahan Pasien Covid-19 di Rumah Sakit Zainoel Abidin Banda Aceh. Jurnal Kedokteran Nanggroe Medika, 6(3), 18–28.
Qawasmeh, M. Al, Aldabbour, B., Momani, A., Obiedat, D., Alhayek, K., Kofahi, R., Yassin, A., & El-Salem, K. (2020). Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke. Stroke Research and Treatment, 2020, 1–9. https://doi.org/10.1155/2020/1920583
Schuh, H. B., Hooli, S., Ahmed, S., King, C., Roy, A. D., Lufesi, N., Islam, A. A., Mvalo, T., Chowdhury, N. H., & Ginsburg, A. S. (2023). Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia. Frontiers in Pediatrics, 11, 1233532. https://doi.org/10.3389/fped.2023.1233532
DOI: http://dx.doi.org/10.30829/contagion.v8i3.29666
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