Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis

Yunlong Liu, Jie Zheng, Daisong Zhang, Liling Jing, Yunlong Liu, Jie Zheng, Daisong Zhang, Liling Jing

Abstract

Objective: The predictive potential of the neutrophil-to-lymphocyte ratio (NLR) and plasma lactate was investigated in regard to the prognosis of patients with sepsis.

Methods: Sixty-three nonsurgical and nontrauma adult patients with sepsis admitted to the intensive care unit (ICU) from September 2016 to October 2018 were consecutively included in the study. In addition, healthy subjects were assigned to a control group. Neutrophil and lymphocyte counts were evaluated via a complete blood count. Plasma lactate, procalcitonin (PCT), and C-reactive protein (CRP) levels were measured. The main outcome was 28-day mortality.

Results: Neutrophil-to-lymphocyte ratio and plasma lactate levels of the patients were significantly higher than those of control subjects: 19.44 (14.3-34.53) vs 14.09 (8.17-28.99), P = 0.049; and 3.7 (3-6.6) vs 2.72 (2.13-4.3) ng/mL, P = 0.008, respectively. There were no statistical differences in the concentrations of PCT and CRP between nonsurvivors and survivors: 6.1 (3.43-33.59) vs 9.43 (4.24-37.68) ng/mL, P = 0.44; and 108 (77.8-153) vs 114.5 (71.43-162) ng/mL, P = 0.672, respectively. With an optimal cutoff of 14.08, the sensitivity and specificity of NLR for prediction of 28-day mortality were 78.3% and 50%, respectively. And the sensitivity and specificity of plasma lactate level to predict 28-day mortality, at an optimal cutoff value of 2.99 mmol/L, were 82.6% and 55%, respectively.

Conclusions: Neutrophil-to-lymphocyte ratio and plasma lactate were associated with poor outcomes in patients with sepsis and predicted mortality.

Keywords: mortality; neutrophil-lymphocyte ratio; plasma lactate; prognosis; sepsis.

© 2019 The Authors. Journal of Clinical Laboratory Analysis Published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
The algorithm of patient enrollment
Figure 2
Figure 2
Levels of neutrophil‐to‐lymphocyte ratio (NLR), plasma lactate, procalcitonin (PCT), and C‐reactive protein (CRP)
Figure 3
Figure 3
Receiver operating characteristics (ROC) of neutrophil‐to‐lymphocyte ratio (NLR) and plasma lactate levels for prediction of mortality in patients with sepsis. The area under the ROC curve was 0.634 for the ability of NLR level to predict 28‐d mortality, with a sensitivity of 78.3% and specificity of 50%. The area under the ROC curve was 0.701 for the ability of plasma lactate level to predict 28‐d mortality, and the sensitivity and specificity were 82.6% and 55%, respectively
Figure 4
Figure 4
Receiver operating characteristics of neutrophil‐to‐lymphocyte ratio (NLR), lactate, and NLR with added lactate in patients with sepsis in relation to 28‐d mortality

References

    1. Vincent JL. Clinical sepsis and septic shock–definition, diagnosis and management principles. Langenbeck's Arch Surg. 2008;393:817‐824.
    1. Torio CM, & Andrews RM.National Inpatient Hospital Costs: the most expensive conditions by Payer, 2011: Healthcare Cost and Utilization Project (HCUP) statistical briefs. . Accessed March 26, 2019.
    1. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long‐term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787‐1794.
    1. van Engelen T, Wiersinga WJ, Scicluna BP, van der Poll T. Biomarkers in sepsis. Crit Care Clin. 2018;34:139‐152.
    1. Tschaikowsky K, Hedwig‐Geissing M, Braun GG, Radespiel‐Troeger M. Predictive value of procalcitonin, interleukin‐6, and C‐reactive protein for survival in postoperative patients with severe sepsis. J Crit Care. 2011;26:54‐64.
    1. Lichtenstern C, Brenner T, Bardenheuer HJ, Weigand MA. Predictors of survival in sepsis: what is the best inflammatory marker to measure? Curr Opin Infect Dis. 2012;25:328‐336.
    1. Gabay C, Kushner I. Acute‐phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340:448‐454.
    1. Zahorec R. Ratio of neutrophil to lymphocyte counts–rapid and simple parameter of systemic inflammation and stress in critically ill. Bratis Lek Listy. 2001;102:5‐14.
    1. Nilsson G, Hedberg P, Öhrvik J. White blood cell count in elderly is clinically useful in predicting long‐term survival. J Aging Res. 2014;2014:475093‐475099.
    1. Weijenberg MP, Feskens E, Kromhout D. White blood cell count and the risk of coronary heart disease and all‐cause mortality in elderly men. Arterioscler Thromb Vasc Biol. 1996;16:499‐503.
    1. Ruggiero C, Metter EJ, Cherubini A, et al. White blood cell count and mortality in the Baltimore longitudinal study of aging. J Am Coll Cardiol. 2007;49:1841‐1850.
    1. Zymlinski R, Biegus J, Sokolski M, et al. Elevated serum lactate is a marker of organ damage related to impaired hemodynamics and indicates poor prognosis in acute heart failure. Eur Heart J. 2013;34:S1517.
    1. Garciaalvarez M, Marik PE, Bellomo R. Sepsis‐associated hyperlactatemia. Crit Care. 2014;18:503‐514.
    1. Morris E, Mccartney D, Lasserson D, Van den Bruel A, Fisher R, Hayward G. Point‐of‐care lactate testing for sepsis at presentation to health care: a systematic review of patient outcomes. Br J Gen Prac. 2017;67:e859‐e870.
    1. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis‐3). JAMA. 2016;315(8):775‐787.
    1. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C‐reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999;3:45‐50.
    1. Gaïni S, Koldkjaer OG, Pedersen C, Pedersen SS. Procalcitonin, lipopolysaccharide‐binding protein, interleukin‐6 and C‐reactive protein in community‐acquired infections and sepsis: a prospective study. Crit Care. 2006;10:R53‐R63.
    1. Akilli NB, Yortanlı M, Mutlu H, et al. Prognostic importance of neutrophil‐lymphocyte ratio in critically ill patients: short‐ and long‐term outcomes. Am J Emerg Med. 2014;32:1476‐1480.
    1. Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularization. Thromb Haemost. 2011;6:591‐599.
    1. Grau AJ, Boddy AW, Dukovic DA, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke. 2004;35:1147‐1152.
    1. de Jager C, Wever PC, Gemen E, et al. The neutrophil‐lymphocyte count ratio in patients with community‐acquired pneumonia. PLoS ONE. 2012;7:e46561‐e46569.
    1. Segel GB, Halterman MW, Lichtman MA. The paradox of the neutrophil's role in tissue injury. J Leukoc Biol. 2011;89:359‐372.
    1. Gennari R, Dominioni L, Imperatori A, Bianchi V, Maroni P, Dionigi R. Alterations in lymphocyte subsets as prognosticators of postoperative infections. Eur J Surg. 1995;161:493‐499.
    1. Tan TP, Arekapudi A, Metha J, Prasad A, Venkatraghavan L. Neutrophil‐lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: a systematic review. Aust N Z J Surg. 2015;85:414‐419.
    1. Wittayachamnankul B, Chentanakij B, Sruamsiri K, Chattipakorn N. The role of central venous oxygen saturation, blood lactate, and central venous‐to‐arterial carbon dioxide partial pressure difference as a goal and prognosis of sepsis treatment. J Crit Care. 2016;36:223‐229.
    1. Mikkelsen ME, Miltiades AN, Gaieski DF, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37:1670‐1677.
    1. Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45:524‐528.

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