Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia?

Dragan Djordjevic, Goran Rondovic, Maja Surbatovic, Ivan Stanojevic, Ivo Udovicic, Tamara Andjelic, Snjezana Zeba, Snezana Milosavljevic, Nikola Stankovic, Dzihan Abazovic, Jasna Jevdjic, Danilo Vojvodic, Dragan Djordjevic, Goran Rondovic, Maja Surbatovic, Ivan Stanojevic, Ivo Udovicic, Tamara Andjelic, Snjezana Zeba, Snezana Milosavljevic, Nikola Stankovic, Dzihan Abazovic, Jasna Jevdjic, Danilo Vojvodic

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet count (MPV/PC) ratio are readily available parameters that might have discriminative power regarding outcome. The aim of our study was to assess prognostic value of these biomarkers regarding outcome in critically ill patients with secondary sepsis and/or trauma.

Methods: A total of 392 critically ill and injured patients, admitted to surgical ICU, were enrolled in a prospective observational study. Leukocyte and platelet counts were recorded upon fulfilling Sepsis-3 criteria and for traumatized Injury Severity Score > 25 points. Patients were divided into four subgroups: peritonitis, pancreatitis, trauma with sepsis, and trauma without sepsis.

Results: NLR and MPV/PC levels were significantly higher in nonsurvivors (AUC/ROC of 0.681 and 0.592, resp., in the peritonitis subgroup; 0.717 and 0.753, resp., in the pancreatitis subgroup); MLR and PLR did not differ significantly. There was no significant difference of investigated biomarkers between survivors and nonsurvivors in trauma patients with and without sepsis except for PLR in the trauma without sepsis subgroup (significantly higher in nonsurvivors, AUC/ROC of 0.719). Independent predictor of lethal outcome was NLR in the whole cohort and in the peritonitis subgroup as well as MPV in the pancreatitis subgroup. Also, there were statistically significant differences in MPV/PC, MLR, and PLR values regarding nature of bacteremia. In general, the lowest levels had been found in patients with Gram-positive blood cultures.

Conclusions: NLR and MPV were very good independent predictors of lethal outcome. For the first time, we demonstrate that nature of bacteremia influences MPV/PC, MLR, and PLR. In heterogeneous cohort subgroup, analysis is essential.

Figures

Figure 1
Figure 1
(a) Receiver operating characteristic (ROC) curve for composite bioscore in the pancreatitis subgroup and the lethal outcome (AUC = 0.874). (b) Percentage of nonsurvivors according to each bioscore point value in the pancreatitis subgroup (darkest shade: cut-off bioscore point value).
Figure 2
Figure 2
Scattergram of MPV/PC versus PLR for all patients (survivors and nonsurvivors).

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