Effects of Neutrophil-to-Lymphocyte Ratio Combined With Interleukin-6 in Predicting 28-Day Mortality in Patients With Sepsis

Abstract

BackgroundThe current study aimed to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR) combined with interleukin (IL)-6 on admission day and the 28-day mortality of septic patients.Material and MethodsWe conducted an observational retrospective study. Patients with presumed sepsis were included. We observed the correlation of studied biomarkers (NLR, IL-6, PCT, and CRP) and the severity scores (APACHE II and SOFA scores) by plotting scatter plots. The relationships of the studied biomarkers and 28-day mortality were evaluated by using Cox regression model, receiver-operating characteristic (ROC) curve, and reclassification analysis.ResultsA total of 264 patients diagnosed with sepsis were enrolled. It was revealed that IL-6 had the strongest correlation with both APACHE II and SOFA scores, followed by the NLR and PCT, and there was no obvious correlation between CRP and the illness severity. NLR and IL-6 were independent predictors of the 28-day mortality in septic patients in the Cox regression model [NLR, odds ratio 1.281 (95% CI 1.159–1.414), P < 0.001; IL-6, odds ratio 1.017 (95% CI 1.005–1.028), P=0.004]. The area under the ROC curve (AUC) of NLR, IL-6 and NLR plus IL-6 (NLR_IL-6) was 0.776, 0.849, and 0.904, respectively.ConclusionOur study showed that the levels of NLR and IL-6 were significantly higher in the deceased patients with sepsis. NLR and IL-6 appeared to be independent predictors of 28-day mortality in septic patients. Moreover, NLR combined with IL-6 could dramatically enhance the prediction value of 28-day mortality.

Efficiency of Monocyte/High-Density Lipoprotein Cholesterol Ratio Combined With Neutrophil/Lymphocyte Ratio in Predicting 28-Day Mortality in Patients With Sepsis

“…Recently, several reports have documented the potential utility of NLR as a diagnostic parameter that is closely related to miscellaneous diseases, including inflammation, ischemic cerebrovascular disease, cancer, and trauma ( 20 , 35 – 40 ). In our observational study, we found that NLR in patients who died were remarkably elevated compared with those with mild cases ( P < 0.01) ( 41 ), which is in accordance with the previous study showing that an inflammatory reactive state typically led to neutrophilia and relative lymphocytopenia ( 42 ). The AUC value of NLR corresponded to 0.827 with 69.62% sensitivity and 89.74% specificity at the optimal cutoff value of 5.51.…”

“…In our observational study, we found that NLR in patients who died were remarkably elevated compared with those with mild cases (P < 0.01) (41), which is in accordance with the previous study showing that an inflammatory reactive state typically led to neutrophilia and relative lymphocytopenia (42). The AUC value of NLR corresponded to 0.827 with 69.62% sensitivity and 89.74% specificity at the optimal cutoff value of 5.51.…”

Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases

“…The authors proposed a NLR cut-off value of 5 for diagnosis of infection or sepsis when exclusion criteria are used [ 21 ]. A recent observational study demonstrated that NLR and IL-6 appeared to be independent predictors of 28-day mortality in septic patients [ 22 ]. Moreover, Jang et al conducted a clustering analysis showing that age, NLR and delta neutrophil index (DNI) were the most robust predictors for sepsis status in all subjects, as well as in cluster-specific groups [ 23 ].…”

Advances in Immune Monitoring Approaches for Sepsis-Induced Immunosuppression

“…Leukocyte markers reflecting the changes in immune cell subpopulations can be potentially helpful ( 165 ). Meanwhile, the combined use of indicators like neutrophil-to-lymphocyte ratio and monocyte/high-density lipoprotein cholesterol ratio reportedly has a better performance in predicting mortality for septic patients than a single parameter did ( 166 – 168 ). Although numerous studies have documented that immune monitoring indicators can predict multiple clinical endpoints for septic patients, including short- or long-term mortality, hospital-acquired infections, and organ dysfunction, basically no specific biomarkers are found to achieve a consistently good performance in predicting all these outcomes ( 5 ).…”