Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study

Eduarda Cristina Martins, Lilian da Fe Silveira, Karin Viegas, Andrea Diez Beck, Geferson Fioravantti Júnior, Rafael Viegas Cremonese, Priscila Schmidt Lora, Eduarda Cristina Martins, Lilian da Fe Silveira, Karin Viegas, Andrea Diez Beck, Geferson Fioravantti Júnior, Rafael Viegas Cremonese, Priscila Schmidt Lora

Abstract

Objective: To evaluate the neutrophil-lymphocyte ratio as a predictor of sepsis and mortality in patients admitted to an intensive care unit.

Methods: Case-control study of adult patients admitted to an intensive care unit. Patients who had sepsis as the reason for admission and who had a previous complete blood count examination were included as case patients. The following statistical analyses were performed: ROC curves, binary logistic regression, and Mann-Whitney and Pearson's chi-square tests. p < 0.05 was considered significant.

Results: The ROC curve values were 0.62 for neutrophil-lymphocyte ratio, 0.98 for band neutrophils and 0.51 for total leukocytes. The presence of a neutrophil-lymphocyte ratio greater than 5.0, leukocyte count above 12,000mm3/mL and band neutrophil percentage above 10% were risk factors for sepsis; however, only the SAPS 3 and SOFA score were related to patient mortality.

Conclusion: The neutrophil-lymphocyte ratio and band neutrophils in combination with other parameters may be markers for the early detection of sepsis in intensive care units.

Conflict of interest statement

Conflicts of interest: None.

References

    1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304–377.
    1. Prescott HC, Calfee CS, Thompson BT, Angus DC, Liu VX. Toward Smarter Lumping and Smarter Splitting: Rethinking Strategies for Sepsis and Acute Respiratory Distress Syndrome Clinical Trial Design. Am J Respir Crit Care Med. 2016;194(2):147–155.
    1. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372(17):1629–1638.
    1. Maclay T, Rephann A. The impact of early identification and a critical care-based sepsis response team on sepsis outcomes. Crit Care Nurse. 2017;37(6):88–91.
    1. Finkelsztein EJ, Jones DS, Ma KC, Pabón MA, Delgado T, Nakahira K, et al. Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit. Crit Care. 2017;21(1):73–73.
    1. Martin JB, Badeaux JE. Interpreting laboratory tests in infection: making sense of biomarkers in sepsis and systemic inflammatory response syndrome for intensive care unit patients. Crit Care Nurs Clin North Am. 2017;29(1):119–130.
    1. Lora-Andosilla M, Cantillo-García K, Borré-Naranjo D, Buelvas-Villalba M, Ortiz-Ruiz G, Dueñas-Castell C. Ortiz-Ruiz G, Dueñas-Castell C. Sepsis. 3rd ed. New York: Springer-Verlag; 2018. Biomarkers in sepsis; pp. 39–50.
    1. Dal-Pizzol F, Ritter C. À procura do Santo Graal: aonde vamos com os biomarcadores na sepse? Rev Bras Ter Intensiva. 2012;24(2):117–118. Internet.
    1. Nobre V, Borges I, Núcleo Interdisciplinar de Investigação em Medicina Intensiva Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections. Rev Bras Ter Intensiva. 2016;28(2):179–189.
    1. de Jager CP, Wever PC, Gemen EF, Kusters R, van Gageldonk-Lafeber AB, van der Poll T, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One. 2012;7(10):e46561.
    1. Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Smith AM, et al. The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR. J Gastrointest Surg. 2013;17(4):675–681.
    1. Lanziotti VS, Póvoa P, Soares M, Silva JR, Barbosa AP, Salluh JI. Use of biomarkers in pediatric sepsis: literature review. Rev Bras Ter Intensiva. 2016;28(4):472–482.
    1. Yilmaz H, Cakmak M, Inan O, Darcin T, Akcay A. Can neutrophil-lymphocyte ratio be independent risk factor for predicting acute kidney injury in patients with severe sepsis? Ren Fail. 2015;37(2):225–229.
    1. Malta M, Cardoso LO, Bastos FI, Magnanini MM, Silva CM. STROBE initiative: guidelines on reporting observational studies. Rev Saude Publica. 2010;44(3):559–565.
    1. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Chest. 6. Vol. 101. American College of Chest Physicians/Society of Critical Care Medicine; 1992. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee; pp. 1644–1655.
    1. Urbaniak GC, Plous S. Research Randomizer. [2019 Jan 21]. Internet. c1997-2019. Available from:
    1. Zampieri FG, Soares M, Borges LP, Salluh JI, Ranzani OT. The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil. Rev Bras Ter Intensiva. 2017;29(4):418–426.
    1. Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le Gall JR, SAPS 3 Investigators SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005;31(10):1345–1355. Erratum in Intensive Care Med. 2006;32(5):796.
    1. Gürol G, Ciftci IH, Terizi HA, Atasoy AR, Ozbek A, Köroglu M. Are there standardized cutoff values for neutrophil-lymphocyte ratios in bacteremia or sepsis. J Microbiol Biotechnol. 2015;25(4):521–525.
    1. Williams JM, Greenslade JH, McKenzie JV, Chu K, Brown AF, Lipman J. Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction: Insights from a Prospective Database of ED Patients with Infection. Chest. 2017;151(3):586–596.
    1. Machado FR, Cavalcanti AB, Bozza FA, Ferreira EM, Angotti Carrara FS, Sousa JL, Caixeta N, Salomao R, Angus DC, Pontes Azevedo LC, SPREAD Investigators. Latin American Sepsis Institute Network The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study. Lancet Infect Dis. 2017;17(11):1180–1189.
    1. Westphal GA, Feijó J, Andrade PS, Trindade L, Suchard C, Monteiro MA, et al. Estratégia de detecção precoce e redução de mortalidade na sepse grave. Rev Bras Ter Intensiva. 2009;21(2):113–123.
    1. Miller EJ, Linge HM. Age-related changes in immunological and physiological responses following pulmonary challenge. Int J Mol Sci. 2017;18(6) pii: E1294.
    1. Banerjee D, Opal SM. Age, exercise, and the outcome of sepsis. Crit Care. 2017;21(1):286–286.
    1. SepNet Critical Care Trials Group Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med. 2016;42(12):1980–1989.
    1. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308–1316.
    1. van Vught LA, Wiewel MA, Hoogendijk AJ, Frencken JF, Scicluna BP, Klouwenberg PM, et al. The host response in patients with sepsis developing intensive care unit-acquired secondary infections. Am J Respir Crit Care Med. 2017;196(4):458–470.
    1. Knoop ST, Skrede S, Langeland N, Flaatten HK. Epidemiology and impact on all-cause mortality of sepsis in Norwegian hospitals: A national retrospective study. PLoS One. 2017;12(11):e0187990.
    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315(8):801–810.
    1. Paary TT, Kalaiselvan MS, Renuka MK, Arunkumar AS. Clinical profile and outcome of patients with severe sepsis treated in an intensive care unit in India. Ceylon Med J. 2016;61(4):181–184.
    1. Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44(6):925–928.
    1. Machado FR, Assunção MS, Cavalcanti AB, Japiassú AM, Azevedo LC, Oliveira MC. Getting a consensus: advantages and disadvantages of Sepsis 3 in the context of middle-income settings. Rev Bras Ter Intensiva. 2016;28(4):361–365.
    1. Bakker J. Lactate is THE target for early resuscitation in sepsis. Rev Bras Ter Intensiva. 2017;29(2):124–127.
    1. 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.
    1. 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–R192.
    1. Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med. 2017;35(2):234–239.
    1. Zhang HB, Chen J, Lan QF, Ma XJ, Zhang SY. Diagnostic values of red cell distribution width, platelet distribution width and neutrophil lymphocyte count ratio for sepsis. Exp Ther Med. 2016;12(4):2215–2219.
    1. Gupta S, Sakhuja A, Kumar G, McGrath E, Nanchal RS, Kashani KB. Culture-negative severe sepsis: nationwide trends and outcomes. Chest. 2016;150(6):1251–1259.
    1. Vincent JL, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet. 2013;381(9868):774–775.
    1. Etzell JE. To and front on band count reporting and clinical utility. Northfield, IL: Cap Today; 2010. [2019 Jan 21]. Internet. Available from: .
    1. Lawrence SM, Eckert J, Makoni M, Pereira HA. Is the use of complete blood counts with manual differentials an antiquated method of determining neutrophil composition in newborns? Ann Clin Lab Sci. 2015;45(4):403–413.
    1. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, INTERHEART Study Investigators Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–952.
    1. Barreto LM, Torga JP, Coelho SV, Nobre V. Main characteristics observed in patients with hematologic diseases admitted to an intensive care unit of a Brazilian university hospital. Rev Bras Ter Intensiva. 2015;27(3):212–219.

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