Neutrophil to lymphocyte ratio (NLR) as a prognostic marker for in-hospital mortality of patients with sepsis: A secondary analysis based on a single-center, retrospective, cohort study

Jie Ni, Hongye Wang, Yue Li, Yimei Shu, Yihai Liu, Jie Ni, Hongye Wang, Yue Li, Yimei Shu, Yihai Liu

Abstract

Neutrophil-to-lymphocyte ratio (NLR) has been reported to serve as a prognostic marker in inflammatory diseases. The purpose of this study was to evaluate the association of NLR at admission with in-hospital mortality in patients with sepsis presenting to emergency department.This was a secondary analysis based on a single-center, retrospective, cohort study. Patients with sepsis admitted to an academic emergency department between January 2010 and January 2015 were enrolled. NLR of patients was analyzed from the hospital's electronic health record (EHR) system. A total of 174 adult patients, of which 80 (46.0%) died in hospital. The primary outcome was in-hospital mortality. Secondary outcome was 28-day mortality.Contrary to previous studies, a larger NLR was found to have less odds of in-hospital mortality, as well as the presence of bacteremia. Patients who has severe/shock or had a history of chronic heart failure (CHF) had larger odds of death during hospital. Multivariate logistic regression analysis indicated that low NLR was an independent predictor of in-hospital mortality (OR = -0.98; 95% CI -0.96 to -0.99; P = .022). However, no correlation was found between the NLR and 28-day hospital mortality in patients with sepsis (P = .988). As a predictor of in-hospital survival, the area under curve (AUC) of the NLR was 0.622 (95%CI 0.54-0.71; P = .006) and the cut-off value was 9.11 with 0.551 sensitivity and 0.707 specificity.NLR at admission was an independent predictor of in-hospital mortality of sepsis patients.

Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Receiver operating curve of neutrophil-to-lymphocyte ratio as a predictor. Area under curve was 0.62 (0.54–0.71) with cut-off of 9.11.

References

    1. Prescott HC, Osterholzer JJ, Langa KM, et al. Late mortality after sepsis: propensity matched cohort study. BMJ 2016;353:i2375.
    1. Abou Dagher G, Hajjar K, Khoury C, et al. Outcomes of patients with systolic heart failure presenting with sepsis to the emergency department of a tertiary hospital: a retrospective chart review study from Lebanon. BMJ Open 2018;8:e022185.
    1. Bouza C, Martinez-Ales G, Lopez-Cuadrado T. The impact of dementia on hospital outcomes for elderly patients with sepsis: a population-based study. PLoS One 2019;14:e0212196.
    1. Martin-Loeches I, Guia MC, Vallecoccia MS, 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;9:26.
    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;102:5–14.
    1. Sarraf KM, Belcher E, Raevsky E, et al. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg 2009;137:425–8.
    1. Cho H, Hur HW, Kim SW, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 2009;58:15–23.
    1. Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 2012;19:217–24.
    1. Liu X, Shen Y, Wang H, et al. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: a prospective observational study. Mediators Inflamm 2016;2016:8191254.
    1. Hwang SY, Shin TG, Jo IJ, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017;35:234–9.
    1. Liu Y, Zheng J, Zhang D, et al. Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis. J Clin Lab Anal 2019;33:1–6.
    1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:801–10.
    1. Bu X, Zhang L, Chen P, et al. Relation of neutrophil-to-lymphocyte ratio to acute kidney injury in patients with sepsis and septic shock: a retrospective study. Int Immunopharmacol 2019;70:372–7.
    1. Riche F, Gayat E, Barthelemy R, et al. Reversal of neutrophil-to-lymphocyte count ratio in early versus late death from septic shock. Crit Care 2015;19:439.
    1. Salciccioli JD, Marshall DC, Pimentel MA, et al. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care 2015;19:13.
    1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369:840–51.
    1. Bermejo-Martin JF, Tamayo E, Ruiz G, et al. Express, groups G. Circulating neutrophil counts and mortality in septic shock. Crit Care 2014;18:407.
    1. Legrand M, Max A, Peigne V, et al. Survival in neutropenic patients with severe sepsis or septic shock. Crit Care Med 2012;40:43–9.
    1. Rimmele T, Payen D, Cantaluppi V, et al. Immune cell phenotype and function in sepsis. Shock 2016;45:282–91.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir