Comparative Analysis of Platelet-to-Lymphocyte Ratio and Neutrophil-to-Platelet Ratio as Diagnostic Markers in Dengue and Malaria
Comparative Analysis of Platelet-to-Lymphocyte Ratio and Neutrophil-to-Platelet Ratio
DOI:
https://doi.org/10.54393/pjhs.v6i6.3357Keywords:
Dengue Fever, Malaria, Platelet-to-Lymphocyte Ratio, Neutrophil-to-Platelet Ratio, Diagnostic Marker, Febrile IllnessAbstract
Dengue fever and malaria are endemic febrile illnesses in South Asia that often present with overlapping clinical features. Accurate differentiation is essential for timely and appropriate treatment. Inflammatory biomarkers such as the Platelet-to-Lymphocyte Ratio (PLR) and Neutrophil-to-Platelet Ratio (NPR) may aid diagnostic decision-making. Objectives: To evaluate the role of PLR and NPR as diagnostic markers in distinguishing dengue fever from malaria in patients presenting with acute febrile illness. Methods: A cross-sectional comparative study was conducted at LUMHS, Hyderabad, over 6 months. A total of 116 patients (58 each with confirmed dengue and malaria) were enrolled using non-probability consecutive sampling. Clinical data and complete blood counts were collected. PLR and NPR were calculated and analyzed for diagnostic accuracy using SPSS version 21.0. ROC curve analysis determined optimal cutoffs, sensitivity, and specificity. Results: The mean PLR was significantly lower in dengue (109.7 ± 58.2) compared to malaria (131.6 ± 69.3) (p=0.034). NPR did not show a significant intergroup difference (p=0.321). At a cutoff of 73.89, PLR demonstrated moderate sensitivity (65.52%) and low specificity (36.21%). NPR showed high specificity (100%) but no sensitivity (0%) at a cutoff of 0.0500. Conclusions: PLR can be considered a modestly useful marker in differentiating dengue from malaria, while NPR lacks diagnostic sensitivity. These findings suggest that PLR, in conjunction with clinical evaluation, may support early differentiation between the two diseases.
References
Tejo AM, Hamasaki DT, Menezes LM, Ho YL. Severe Dengue in the Intensive Care Unit. Journal of Intensive Medicine. 2024 Jan; 4(1): 16-33. doi: 10.1016/j.jointm.2023.07.007. DOI: https://doi.org/10.1016/j.jointm.2023.07.007
Urmi TJ, Al Mosharrafa R, Hossain MJ, Rahman MS, Kadir MF, Islam MR. Frequent Outbreaks of Dengue Fever in South Asian Countries - A Correspondence Analyzing Causative Factors and Ways to Avert. Health Science Reports. 2023 Sep; 6(10): e1598. doi: 10.1002/hsr2.1598. DOI: https://doi.org/10.1002/hsr2.1598
World Health Organization. Disease Outbreak News: Dengue - Global Situation 2024. 2024 Aug.
Thellier M, Gemegah AA, Tantaoui I. Global Fight Against Malaria: Goals and Achievements 1900-2022. Journal of Clinical Medicine. 2024 Sep; 13(19): 5680. doi: 10.3390/jcm13195680. DOI: https://doi.org/10.3390/jcm13195680
Tabassum S, Naeem A, Nazir A, Naeem F, Gill S, Tabassum S. Year-Round Dengue Fever in Pakistan, Highlighting the Surge Amidst Ongoing Flood Havoc and the COVID-19 Pandemic: A Comprehensive Review. Annals of Medicine and Surgery. 2023 Apr; 85(4): 908-12. doi: 10.1097/MS9.0000000000000418. DOI: https://doi.org/10.1097/MS9.0000000000000418
Tabassum S, Kalsoom T, Zaheer Z, Naeem A, Afifi A, Ohadi L. Reflections on the Surge in Malaria Cases After Unprecedented Flooding in Pakistan - A Commentary. Health Science Reports. 2023 Oct; 6(10): e1620. doi: 10.1002/hsr2.1620. DOI: https://doi.org/10.1002/hsr2.1620
Venkataswamy Reddy P, Ahuja A, Asthana B, Singh K, Sagoo G. To Evaluate Platelet Indices, Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio as Prognostic and Risk Factors in Patients with Coronary Artery Disease. Indian Journal of Hematology and Blood Transfusion. 2024 Jan; 40(1): 103-7. doi: 10.1007/s12288-023-01664-z. DOI: https://doi.org/10.1007/s12288-023-01664-z
Anoun J, Ajmi M, Riahi S, Dhaha Y, Mbarki D, Ben Hassine I, et al. Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Bacterial Infections: Contributions to Diagnostic Strategies in a Tertiary Care Hospital in Tunisia. F1000Research. 2024 Sep; 13: 978. doi: 10.12688/f1000research.146952.2. DOI: https://doi.org/10.12688/f1000research.146952.2
Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Annals of Laboratory Medicine. 2019 Feb; 39(4): 345. doi: 10.3343/alm.2019.39.4.345. DOI: https://doi.org/10.3343/alm.2019.39.4.345
Sajjad Z, Tashfeen S, Shahid S, Bibi A, Irfan R, Naeem U, et al. Correlation of Total Leucocyte Count, Neutrophil to Lymphocyte Ratio, and Platelet Count with Duration of Hospital Stay in Dengue Fever. Life and Science. 2025 Jan; 6(1): 6-. doi: 10.37185/LnS.1.1.466. DOI: https://doi.org/10.37185/LnS.1.1.466
Mehwash I, Shah MM, Muhammad KW, Zia U, Numan SM, Khan SJ. Malaria and Dengue Co-Infection: A Comprehensive Study in Peshawar, Pakistan. Cureus. 2024 Dec; 16(12).
Kotepui M, PhunPhuech B, Phiwklam N, Uthaisar K. Differentiating Between Dengue Fever and Malaria Using Hematological Parameters in Endemic Areas of Thailand. Infectious Diseases of Poverty. 2017 Apr; 6(2): 29-37. doi: 10.1186/s40249-017-0238-x. DOI: https://doi.org/10.1186/s40249-017-0238-x
Alsedig K, Eldigail MH, Elduma AH, Elaagip A, Altahir O, Siam HA, et al. Prevalence of Malaria and Dengue Co-Infections Among Febrile Patients During Dengue Transmission Season in Kassala, Eastern Sudan. PLOS Neglected Tropical Diseases. 2023 Oct; 17(10): e0011660. doi: 10.1371/journal.pntd.0011660. DOI: https://doi.org/10.1371/journal.pntd.0011660
Iqbal NT, Ahmed K, Khalid A, Imtiaz K, Ali QM, Munir T, et al. Clinical Characteristics and Serotype Association of Dengue and Dengue-Like Illness in Pakistan. PLOS Neglected Tropical Diseases. 2025 May; 19(5): e0012978. doi: 10.1371/journal.pntd.0012978. DOI: https://doi.org/10.1371/journal.pntd.0012978
Karunaratna S, Ranaweera D, Vitharana H, Ranaweera P, Mendis K, Fernando D. Thrombocytopenia in Malaria: A Red-Herring for Dengue, Delaying the Diagnosis of Imported Malaria. Journal of Global Infectious Diseases. 2021 Oct; 13(4): 172-6. doi: 10.4103/jgid.jgid_9_21. DOI: https://doi.org/10.4103/jgid.jgid_9_21
Iqbal Z, Memon SS, Maheshwari JD, Zafar U, Lathiya N, Khalid SS. Comparison of Clinical and Biological/Laboratory Findings of Malaria and Dengue Infection in Karachi: A Cross-Sectional Survey. Pakistan Journal of Medical and Health Sciences. 2022 Nov; 16(9): 933-. doi: 10.53350/pjmhs22169933. DOI: https://doi.org/10.53350/pjmhs22169933
Obeagu EI. The Diagnostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Malaria: Insights and Implications - A Narrative Review. Annals of Medicine and Surgery. 2025 Jun; 87(6): 3393-402. doi: 10.1097/MS9.0000000000003156. DOI: https://doi.org/10.1097/MS9.0000000000003156
Kabir MA, Zilouchian H, Younas MA, Asghar W. Dengue Detection: Advances in Diagnostic Tools from Conventional Technology to Point of Care. Biosensors. 2021 Jun; 11(7): 206. doi: 10.3390/bios11070206. DOI: https://doi.org/10.3390/bios11070206
Bhatt P, Sabeena SP, Varma M, Arunkumar G. Current Understanding of the Pathogenesis of Dengue Virus Infection. Current Microbiology. 2021 Jan; 78(1): 17-32. doi: 10.1007/s00284-020-02284-w. DOI: https://doi.org/10.1007/s00284-020-02284-w
Azeredo EL, Monteiro RQ, De-Oliveira Pinto LM. Thrombocytopenia in Dengue: Interrelationship Between Virus and the Imbalance Between Coagulation and Fibrinolysis and Inflammatory Mediators. Mediators of Inflammation. 2015; 2015(1): 313842. doi: 10.1155/2015/313842. DOI: https://doi.org/10.1155/2015/313842
Hossain MJ, Das M, Shahjahan M, Islam MW, Towhid ST. Clinical and Hematological Manifestation of Dengue Patients in 2022 Outbreak: A Tertiary Care Hospital-Based Cross-Sectional Study. Health Science Reports. 2025 Jan; 8(1): e70356. doi: 10.1002/hsr2.70356. DOI: https://doi.org/10.1002/hsr2.70356
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Health Sciences

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments