Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever

Are Naess, Siri Saervold Nilssen, Reidun Mo, Geir Egil Eide, Haakon Sjursen, Are Naess, Siri Saervold Nilssen, Reidun Mo, Geir Egil Eide, Haakon Sjursen

Abstract

Purpose: To study the role of the neutrophil:lymphocyte ratio (NLR) and monocyte:lymphocyte ratio (MLR) in discriminating between different patient groups hospitalized for fever due to infection and those without infection.

Methods: For 299 patients admitted to hospital for fever with unknown cause, a number of characteristics including NLR and MLR were recorded. These characteristics were used in a multiple multinomial regression analysis to estimate the probability of a final diagnostic group of bacterial, viral, clinically confirmed, or no infection.

Results: Both NLR and MLR significantly predicted final diagnostic group. Being highly correlated, however, both variables could not be retained in the same model. Both variables also interacted significantly with duration of fever. Generally, higher values of NLR and MLR indicated larger probabilities for bacterial infection and low probabilities for viral infection. Patients with septicemia had significantly higher NLR compared to patients with other bacterial infections with fever for less than one week. White blood cell counts, neutrophil counts, and C-reactive proteins did not differ significantly between septicemia and the other bacterial infection groups.

Conclusions: NLR is a more useful diagnostic tool to identify patients with septicemia than other more commonly used diagnostic blood tests. NLR and MLR may be useful in the diagnosis of bacterial infection among patients hospitalized for fever.

Keywords: Fever; Infections; Monocyte:lymphocyte ratio (MLR); Neutrophil:lymphocyte ratio (NLR).

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Scattergram on log10scales of monocyte:lymphocyte ratio (MLR) versus neutrophil:lymphocyte ratio (NLR) (Pearson’s R: 0.63, Spearman’s rho = 0.78) for 265 patients hospitalized for fever with unknown diagnosis
Fig. 2
Fig. 2
Predicted probabilities of diagnostic groups by neutrophil:lymphocyte ratio (NLR) based on an unadjusted multinomial regression model for 266 patients admitted for fever
Fig. 3
Fig. 3
Predicted probabilities of diagnostic group by monocyte:lymphocyte ratio (MLR) based on an unadjusted multinomial regression model for 266 patients admitted for fever
Fig. 4
Fig. 4
Receiver operating characteristic (ROC) curves for bacterial infection from 265 patients admitted for fever without diagnosis. Areas under the curves were 0.708 for the neutrophil:lymphocyte ratio (NLR) and 0.688 for the monocyte:lymphocyte ratio (MLR), respectively

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