The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study

Kim Westerdijk, Koen S Simons, Marissa Zegers, Peter C Wever, Peter Pickkers, Cornelis P C de Jager, Kim Westerdijk, Koen S Simons, Marissa Zegers, Peter C Wever, Peter Pickkers, Cornelis P C de Jager

Abstract

Background: Early diagnosis and treatment has proven to be of utmost importance in the outcome of sepsis patients. We compared the accuracy of the neutrophil-lymphocyte count ratio (NLCR) to conventional inflammatory markers in patients admitted to the Intensive Care Unit (ICU).

Methods: We performed a retrospective cohort study consisting of 276 ICU patients with sepsis and 388 ICU patients without sepsis. We compared the NLCR as well as C-reactive protein (CRP) level, procalcitonin (PCT) level, white blood cell (WBC) count, neutrophil count and lymphocyte count on ICU admission between sepsis and non-sepsis ICU patients. To evaluate the sensitivity and specificity, we constructed receiver operating characteristics (ROC) curves.

Results: Significant differences in NLCR values were observed between sepsis and non-sepsis patients (15.3 [10.8-38.2] (median [interquartile range] vs. 9.3 [6.2-14.5]; P<0.001), as well as for CRP level, PCT level and lymphocyte count. The area under the ROC curve (AUROC) of the NLCR was 0.66 (95%CI = 0.62-0.71). AUROC was significantly higher for CRP and PCT level with AUROC's of 0.89 (95%CI 0.87-0.92) and 0.88 (95%CI 0.86-0.91) respectively.

Conclusions: The NLCR is less suitable than conventional inflammatory markers CRP and PCT to detect the presence of sepsis in ICU patients.

Trial registration: ClinicalTrials.gov NCT01274819.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Enrollment flow chart.
Fig 1. Enrollment flow chart.
DLA = Dynamic Light Application.
Fig 2. Receiver operating characteristics (ROC) curves…
Fig 2. Receiver operating characteristics (ROC) curves of inflammatory markers for differentiating sepsis and bacteremia.
(A) ROC curves of inflammatory markers for differentiating sepsis. (B) ROC curves of inflammatory markers for differentiating bacteremia. CRP = C-reactive protein; PCT = procalcitonin; WBC = white blood cell; NLCR = neutrophil-lymphocyte count ratio.

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