Biomarcadores hematológicos y gravedad clínico-radiológica en la tuberculosis pediátrica hospitalaria: estudio de cohorte histórica

Introduction. Pediatric tuberculosis (TB) remains a relevant cause of childhood morbidity and mortality, and early identification of severe forms remains a persistent clinical challenge. Objective. To evaluate the association between hematological biomarkers and clinical-radiological severity, intensive care unit (ICU) admission, and mortality in hospitalized pediatric TB patients. Materials and methods. Observational, analytical, historical-cohort study through review of electronic medical records of patients treated between 2019 and 2024 at the Hospital Pediátrico Dr. Roberto Gilbert Elizalde (Guayaquil, Ecuador). Of 151 eligible records, 123 patients were included and classified as severe or non-severe TB according to WHO/Wiseman criteria. Biomarkers were compared by severity, ICU admission, and mortality using the Mann-Whitney U test, ROC curves, and logistic regression. Results. TB was severe in 61% of patients, 38% required ICU admission, and mortality was 3%. The neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) were significantly associated with severity (p = 0,005 and p = 0,021, respectively), with an age-adjusted area under the curve (AUC) of 0,634 and 0,606, absolute lymphocyte count showed the strongest association (p < 0.001). The multivariable model was globally significant (p = 0,009) but did not outperform NLR alone. No biomarker was associated with ICU admission; mortality analysis was exploratory given the low number of events (n = 4). Conclusion. NLR and MLR were associated with pediatric TB severity, although with limited discriminative capacity (AUC < 0,70), insufficient for use as individual clinical predictors.