الفهرس 
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Abstract
Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy in children with a peak incidence in the first 2 years of life. DCM is a primary cardiac disorder, which is characterized by left or bilateral ventricular dilatation and systolic dysfunction. Heart failure may be the first presentation of DCM, many biomarkers have been used in the prognosis of DCM as B-type natriuretic peptide (BNP), ultrasensitive troponins, and soluble protein ST2. Neutrophil to lymphocyte ratio (NLR) is a new inflammatory biomarker and used in the staging prognosis of several chronic diseases. As heart failure is an inflammatory process and associated with great stress that activates hypothalamic-pituitary-adrenal axis, resulting in increase of cortisol levels, shift in the leukocytes differential count and lymphopenia. Araújo et al reported use of NLR as a good prognostic marker for DCM in childhood due to its easy availability, low cost. The objectives of this work were to evaluate NLR and serum levels of BNP in children with dilated cardiomyopathy, to evaluate the predictive and prognostic value of NLR in these patients, and to correlate its levels with BNP levels and with other clinical and echocardiographic data of the patients. This study was conducted on 25 children with DCM. They were chosen from those admitted at the Pediatric Cardiology Unit, Pediatric Department, Tanta University Hospital during the period from January 2021 to January 2022. They were 16 males and 9 females. Their age ranged from 4 months to 13 years. Twenty-five healthy children matched for age and sex were enrolled as the control group. They were 15 males and 10 females. Their age ranged from 6 months to 14 years. All children in this study were subjected to the following: • Complete history taking. • Clinical examination: including heart rate, signs of heart failure, and complete local cardiac examination. • Investigations: A. Plain X-ray chest and heart: CTR was measured for assessment of cardiomegaly. B. Electrocardiogram (ECG). C. Echocardiographic evaluation of LV function and dimensions. D. Routine laboratory: liver and renal function tests. E. CBC with differentiation to evaluate neutrophil to lymphocyte ratio NLR. F. Serum level of BNP. All children with dilated cardiomyopathy were followed up for adverse outcome eg: re-addmission and mortality for a period of 3 months. The results of the present study revealed that: • There was no significant difference between the two groups as regard age and sex. While the weight of children with DCM was statistically significantly lower than that of the control group. • According to modified Ross classification of HF, 24% of the patient group were in class IV, 56% were in class III, and 20% were in class II. • There was A significant increase of RR and HR in children with DCM as compared to the control group. • There was a significant increase of CTR (by chest X-ray) in children with DCM as compared to the control group. • There was a significant decrease of LV EF% and LV FS% (systolic dysfunction of LV) in patients with DCM as compared to the control group. • BNP and NLR were significantly higher in children with DCM as compared to the control group. • In children with DCM, 20% of cases showed good prognosis, 56% of cases were readmitted, whereas 24% of cases died. • There was significant increase in NLR in patients who died more than those who were readmitted, more than those with good prognosis. • NLR was significantly higher in patients with Ross class IV compared to those with class III and class II, P=0.001. • The cutoff point of NLR to predict adverse outcomes in children with DCM was ˃ 2.6, with 87% sensitivity, 79% specificity, 85% PPV, 80% NPV and AUC was 0.89. • The cutoff point of NLR to predict response to treatment in children with DCM was ˂2.85, with 85% sensitivity and 100% specificity • There was statistically significant positive correlation between NLR and both BNP & clinical stage of heart failure. • There was statistically significant negative correlation between NLR and both LV EF% & LV FS%.