Prognostic value of neutrophil- lymphocyte count ratio (NLCR) among adult ICU patients in comparison to APACHE II score and conventional inflammatory markers: a multi center retrospective cohort study

Tao Zhou, Nan Zheng, Xiang Li, Dongmei Zhu, Yi Han, Tao Zhou, Nan Zheng, Xiang Li, Dongmei Zhu, Yi Han

Abstract

Background: Neutrophil-lymphocyte count ratio (NLCR) has been reported as better indicator of bacteremia than procalcitonin (PCT), and more precise predictor of mortality than C-reactive protein (CRP) under various medical conditions. However, large controversy remains upon this topic. To address the discrepancy, our group has compared the efficiency of NLCR with conventional inflammatory markers in predicting the prognosis of critical illness.

Methods: We performed a multi-center retrospective cohort study involving 536 ICU patients with outcomes of survival, 28- and 7-day mortality. NLCR was compared with conventional inflammatory markers such as PCT, CRP, serum lactate (LAC), white blood cell, neutrophil and severity score APACHE II (Acute Physiology and Chronic Health Evaluation II) to evaluate the potential outcomes of critical illness. Then, receiver operating characteristics (ROC) curves were constructed to assess and compare each marker's sensitivity and specificity respectively.

Results: NLCR values were not different between survival and mortality groups. Meanwhile, remarkable differences were observed upon APACHE II score, CRP, PCT and LAC levels between survival and death groups. ROC analysis revealed that NLCR was not competent to predict prognosis of critical illness. The AUROCs of conventional markers such as CRP, PCT, LAC and APACHE II score were more effective in predicting 28- and 7-day mortality.

Conclusions: NLCR is less reliable than conventional markers CRP, PCT, LAC and APACHE II score in assessing severity and in predicting outcomes of critical illness.

Keywords: APACHE II; CRP; Critical illness; Inflammation; Neutrophil lymphocyte count ratio; Procalcitonin.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Enrollment flow chart
Fig. 2
Fig. 2
APACHE II scores and biomarker levels of NLCR, CRP, PCT, and LAC of survival, 28-day mortality, and 7-day mortality group. **p < 0.01 vs survival, ***p < 0.001 vs survival
Fig. 3
Fig. 3
Receiver operating characteristic curves and AUROCs of markers for predicting overall 28-day and 7-day mortality. *P < 0.05, ***P < 0.001 compared with APACHE II, &P < 0.05 compared with LAC, #P < 0.05 compared with PCT. The table below showed the area under the ROC curve value with STD, 95% confidence intervals and P values versus survival group
Fig. 4
Fig. 4
Survival curves of biomarkers divided by respective cutoff values. The table below showed the P values, cutoff values, sensitivity and specificity

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