Predictive value of neutrophil-to-lymphocyte ratio in in-hospital mortality in sepsis patients: A cross-sectional study

Abstract

Objective: To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) in in-hospital mortality in sepsis patients. Methods: A prospective observational cross-sectional study was conducted on 100 patients with septicemia. The data about the patient’s demography, medical history, general examination including pulse rate, blood pressure, etc, use of vasopressor support, need for renal replacement therapy, mechanical ventilation, outcome, and lab parameters including total lymphocyte count with neutrophil-to-lymphocyte ratio were recorded. And parameters between survivals and non-survivals were compared. Results: Out of 100 patients, 80% were from rural backgrounds. Most patients were 50 to 59 years old. 26 Patients were dead. The patients in the nonsurvivor group were older and more had a history of diabetes mellitus when compared with the survivor group. The non-survivor group had a higher NLR, APACHE II, and SOFA score. Conclusions: NLR is a readily available parameter and can be used as a good prognostic indicator for mortality in sepsis patients.

Keywords

Neutrophil-to-lymphocyte ratio / Sepsis / Intensive Care Unit / Mortality / APACHE score / SOFA score

References

[1] Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101(6): 1644-1645.

[2] Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990—2017: Analysis for the Global Burden of Disease Study. Lancet 2020; 395(10219): 200-211.

[3] Martin—Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, Irazabal M, et al. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: A prospective, observational, multicenter cohort study. Ann Intensive Care 2019; 9(1): 26.

[4] Burke J, Wood S, Hermon A, Szakmany T. Improving outcome of sepsis on the ward: Introducing the “Sepsis Six” bundle. Nurs Crit Care 2019; 24(1): 33-39.

[5] Bu X, Zhang L, Chen P, Wu X. Relation of neutrophil—to—lymphocyte ratio to acute kidney injury in patients with sepsis and septic shock: A retrospective study. Int Immunopharm 2019; 70: 372-377.

[6] Zahorec R. Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102(1): 5-14.

[7] Kang MH, Go SI, Song HN, Lee A, Kim SH, Kang JH, et al. The prognostic impact of the neutrophil—to—lymphocyte ratio in patients with small—cell lung cancer. Br J Cancer 2014; 111(3): 452-460.

[8] Sarraf KM, Belcher E, Raevsky E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non—small cell lung cancer. J Thorac Cardiovasc Surg 2009; 137(2): 425-428.

[9] Cho H, Hur HW, Kim SW, Kim SH, Kin JH, Kin YT, et al. Pre—treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 2009; 58(1): 15-23.

[10] Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil—to—lymphocyte ratio in predicting short—and long—term mortality in breast cancer patients. Ann Surg Oncol 2012; 19(1): 217-224.

[11] Kaushik R, Gupta M, Sharma M, Jash D, Jain N, Sinha N, et al. Diagnostic and prognostic role of neutrophil—to—lymphocyte ratio in early and late phase of sepsis. Indian J Crit Care Med 2018; 22(9): 660-663.

[12] Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic significance of neutrophil—to—lymphocyte ratio in patients with sepsis: A prospective observational study. Mediators Inflamm 2016; 2016: 8191254.

[13] De Jager CP, van Wijk PT, Mathoera RB, de Jongh—Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil—lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 2010; 14(5): R192.

[14] Ye W, Chen X, Huang Y, Li Y, Xu Y, Liang Z, et al. The association between neutrophil—to lymphocyte count ratio and mortality in septic patients: A retrospective analysis of the MIMIC—III database. J Thorac Dis 2020; 12(5): 1843-1855.