Comparison of Neutrophils-lymphocytes Ratio and Procalcitonin Parameters in Sepsis Patient Treated in Intensive Care Unit Dr. Wahidin Hospital, Makassar, Indonesia

Abstract

Neutrophils-lymphocytes ratio (NLR) is regarded as a cheap, simple and promising parameter to predict sepsis severity. This study was aimed to compare NLR and procalcitonin (PCT) parameters and its correlation with acute physiology and chronic health evaluation (APACHE) II scoring system in sepsis and severe patients. This retrospective study investigated 65 sepsis patients data in the medical record that been treated in Intensive Care Unit (ICU) in the last 2015 at Dr. Wahidin Sudirohusodo Hospital Makassar. Data collected including neutrophil, lymphocytes, PCT and the APACHE II score. Based on clinical finding and the dependency to vasopressor, the patients were divided into sepsis and severe sepsis groups. The NLR, PCT and APACHE II scores in sepsis and severe sepsis were compared, the cut off point for NLR and PCT were determined and the sensitivity and specificity were calculated. Procalcitonin level was significantly different in sepsis and severe sepsis groups (p<0.001), the difference was not seen for NLR. The Cut off Point (COP) to distinguish between sepsis and severe sepsis for NLR was 9.05 with sensitivity and specificity 59.6 and 50.0%, respectively. For PCT it was 2.89 with sensitivity and specificity 98.2 and 75.0%, respectively. There was a significant positive correlation between APACHE II score with NLR (p = 0.036) and with PCT (p = 0.027). Procalcitoninis superior than NLR in distinguishing sepsis and severe sepsis, however, since a positive correlation found between APACHE II score with NLR and with PCT, NLR can be used as parameter to predict the severity of sepsis in the hospital with limited laboratory facilities.

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

“…Both CRP and procalcitonin were found to have significant associations with NLR. Similar results have been previously proposed by authors, such as Ljungström et al and Xu et al, for CRP and by Merik et al and Arif et al for procalcitonin [ 21 - 24 ]. Most of the above-mentioned studies showed these associations to be of prognostic value as well [ 21 , 23 - 24 ].…”

“…Similar results have been previously proposed by authors, such as Ljungström et al and Xu et al, for CRP and by Merik et al and Arif et al for procalcitonin [ 21 - 24 ]. Most of the above-mentioned studies showed these associations to be of prognostic value as well [ 21 , 23 - 24 ]. Zheng et al, however, reported CRP and procalcitonin to be better biomarkers than NLR for predicting sepsis [ 25 ].…”

Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis

“…The neutrophil to lymphocyte ratio (NLR), is an inflammatory mediator used as predictor of systemic inflammation [1]. Numerous studies conducted around globe have reported about neutrophil to lymphocyte ratio (NLR) as a predictor of prognosis in a variety of cancers (breast, ovary, lung), cardiovascular disorders (coronary procedures and coronary artery bypass grafting), infectious disorders (community-acquired pneumonia, corona) and sepsis in general [1][2][3][4][5].…”

“…Neutrophil to lymphocyte ratio (NLR) is promptly accessible parameter calibrated entirely through a report of complete blood count (CBC); it is economical and simple as compared to the rest of mediators making it potential diagnostic criterion [2][3][4]. Neutrophil to lymphocyte ratio (NLR) is a prominent predictor of severity of disease, if high levels are detected it determines poor prognosis and high mortality within patients of intensive care units [3][4][5]. Elevating levels of neutrophil to lymphocyte ratio (NLR) projects towards the prediction of mortality among sufferers of acute coronary syndrome, intracerebral hemorrhage, polymyositis, dermatomyositis, and cancers [6,7].…”

Neutrophil to lymphocyte ratio as a predictor of treatment response and mortality in septic shock patients in the intensive care unit

“…However, CRP can increase in both infectious and noninfectious diseases and, even though procalcitonin has a well-defined role as a sepsis biomarker, it has inconsistent and variable results for the diagnosis of infectious sepsis, not to mention it is expensive to assess [15,16]. Recently, studies have been undertaken on inflammatory markers obtained from complete blood counts (CBCs) with simple calculations for early recognition of infection and assessing treatment response [17][18][19][20][21][22]. Inflammatory markers obtained by CBCs, such as the NLR, PLR, platelet to mean platelet volume (MPV), have been assessed in different disease groups for their association with hospital mortality [12,13,22,23].…”