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

Abstract

ObjectiveThe predictive potential of the neutrophil‐to‐lymphocyte ratio (NLR) and plasma lactate was investigated in regard to the prognosis of patients with sepsis.MethodsSixty‐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.ResultsNeutrophil‐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.ConclusionsNeutrophil‐to‐lymphocyte ratio and plasma lactate were associated with poor outcomes in patients with sepsis and predicted mortality.

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

“…In our retrospective study, we demonstrated that the NLR, IL-6, and PCT values were significantly higher in the non-survivors than in the survivors ( P < 0.01), which was consistent with the previous studies ( 15 , 40 – 42 ). However, there was no significant difference in CRP levels between survivors and non-survivors.…”

“…Thus, immune-related biomarkers, such as neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), sTREM-1, presepsin, cytokines, and various interleukins, are increasingly being evaluated for their abilities of early recognition and to predict prognosis of sepsis ( 5 , 12 – 14 ). NLR has been found to serve as a convenient prognostic marker in septic patients despite numerous pieces of evidence that reported the correlation between NLR and adverse outcomes of sepsis remained controversial ( 12 , 15 ). As a sign of inflammation, NLR is derived from the absolute counts of neutrophils and absolute lymphocytes.…”

Predicting 30-days mortality for MIMIC-III patients with sepsis-3: a machine learning approach using XGboost

“…Patients with a normal lactate level alone should not be excluded life-threatening sepsis, and with high AG levels regardless of lactate levels, have high rates of mortality and should also be considered for early, aggressive therapy [ 40 ]. However, Liu and Velissaris et al [ 41 , 42 ] clearly pointed out that plasma lactate were associated with poor outcomes in patients with sepsis and predicted mortality. INR is another crucial predictive factor in the machine learning model.…”

Lactate released by inflammatory bone marrow neutrophils induces their mobilization via endothelial GPR81 signaling

“…Neutrophils are highly glycolytic with limited mitochondrial respiration 10,11 . Lactate, a major byproduct of glycolysis, was found to be released by human neutrophils 12 and increased lactate levels are used as a marker for detecting sepsis in patients 13,14 . However, mechanistic reasoning for lactate production by BM neutrophils and its potential role during the early phase of acute inflammation remain elusive.…”