Prisillia Brigitta, I. Kadek Suarca, I.Wayan Bikin Suryawan
Background. Objective assessment of acute asthma severity in children remains challenging, particularly in emergency settings where rapid and accessible biomarkers are needed. The eosinophil-to-lymphocyte ratio (ELR), derived from routine complete blood counts, has emerged as a novel inflammatory marker. This study purposed to evaluate the correlation between ELR and the Pediatric Asthma Severity Score (PASS) in children with acute asthma exacerbation. Materials and methods. This cross-sectional study included children aged 2–18 years admitted to a tertiary hospital with acute asthma exacerbation between January 2022 and December 2025. ELR was calculated from absolute eosinophil and lymphocyte counts obtained at initial emergency department presentation. Asthma severity was assessed using PASS. The association between ELR and PASS was analyzed using the Spearman correlation coefficient. Differences in ELR across severity categories were evaluated using the Kruskal-Wallis test. Receiver operating characteristic (ROC) analysis was performed to assess ELR’s ability to discriminate severe exacerbations. Results. A total of 98 children were analyzed (63.3 % male; median age 9 years). The median PASS was 8 (IQR 2), and the median ELR was 0.25 (IQR 0.36). ELR showed a significant moderate positive correlation with PASS (r = 0.511; p < 0.001). ELR values differed significantly across severity categories (p < 0.001), with higher median ELR levels in moderate and severe exacerbations than in mild cases. However, ROC analysis demonstrated limited discriminatory performance for severe exacerbation (AUC 0.603; 95% CI 0.367–0.840; p = 0.391). Conclusions. ELR is moderately correlated with clinical severity, as assessed by PASS, in children with acute asthma exacerbation. Although ELR may reflect inflammatory burden, its ability to distinguish severe from non-severe exacerbations is limited. Therefore, ELR may serve as an adjunct inflammatory marker in the initial clinical evaluation, but should not be used as a standalone predictor of severe disease. © 2026. The Authors. This is an open access article under the terms of the Creative Commons Attribution 4.0 International License, CC BY, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
Department of Child Health, Wangaya Regional General Hospital, Bali, Denpasar, Indonesia; Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia; Faculty of Medicine, Brawijaya University, East Java, Malang, Indonesia
