Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care
            unit: a case-control study

Martins, Eduarda Cristina; Silveira, Lilian da Fe; Viégas, Karin; Beck, Andrea Diez; Júnior, Geferson Fioravantti; Cremonese, Rafael Viégas; Lora, Priscila Schmidt

doi:10.5935/0103-507x.20190010

Cited by 84 publications

(68 citation statements)

References 39 publications

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“…This study is consistent with previous studies considering NLR as a prognostic marker of sepsis [10][11][12]. These studies proposed NLR not only as a predictor of sepsis but also as a marker of disease severity and worse outcome.…”

Section: Discussionsupporting

confidence: 93%

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Rehman¹,

Khan²,

Aziz³

et al. 2020

Cureus

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Background Neutrophil to lymphocyte ratio (NLR) can be easily calculated from the white cell differential count and is considered an auspicious marker for predicting different diseases, including sepsis. In this study, we aimed to compare the efficacy of NLR as a sepsis marker by comparing it with other markers of sepsis, such as Creactive protein (CRP), procalcitonin, and the Sequential Organ Failure Assessment (SOFA) score. Methods A cross-sectional analytical study was conducted at the Aga Khan University Hospital from July 2019 to December 2019. A total of 168 patients who were admitted to the medicine department with a diagnosis of sepsis on arrival or during the hospital stay were enrolled. The neutrophil to lymphocyte ratio was calculated to form venous samples taken on admission and compared to the level of CRP, procalcitonin, culture reports, and the SOFA score as a predictor of sepsis. Results Out of 168 patients, 55.3% were male. The median age of the participants was 68.40 (interquartile range (IQR): 19.5) years in males and 64.0 (IQR: 18.0) in females. Procalcitonin was performed in 121 (72%) and CRP performed in 61 (36.3%) patients. The NLR showed significant associations with all the tested lab parameters of sepsis, such as CRP (p = 0.02), procalcitonin (p = 0.01), and SOFA score (p = 0.01). Values when analyzed according to culture-positive showed higher values in culture-positive samples but were not statistically significant. Conclusion Neutrophil to lymphocyte ratio is a cheap and rapidly available predictor of sepsis and has shown a significant correlation with other relatively expensive and non-rapidly existing markers of inflammation and sepsis. However, large prospective studies are needed to prove its real effectiveness as a marker of sepsis and its prognosis

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Section: Discussionsupporting

confidence: 93%

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Rehman¹,

Khan²,

Aziz³

et al. 2020

Cureus

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“…Many hematological parameters are currently been utilized to predict outcomes and mortality in patients infected with SARS CoV-2. 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 [ 1–5 ].…”

Section: Introductionmentioning

confidence: 99%

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

Asghar

Khan

Kazmi

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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Background and Objectives: COVID-19 is a global pandemic. In our study, we aimed to utilize the hematological parameters in predicting the prognosis and mortality in COVID-19 patients. Materials and methods: A retrospective, observational study was conducted to include all the admitted patients (n = 191) having COVID-19 Polymerase chain reaction (PCR) positive, and evaluated those for prognosis and disease outcome by utilizing several biochemical and hematological markers. Results: Amongst the patients admitted in the ward versus in the intensive care unit (ICU), there were significant differences in mean hemoglobin (P = 0.003), total leukocyte count (P = 0.001), absolute neutrophil and lymphocyte counts (P < 0.001), absolute monocyte count (P = 0.019), Neutrophil-to-Lymphocyte ratio (NLR) and Lymphocyte-to-Monocyte ratio (LMR) (P < 0.001), Platelet-to-Lymphocyte ratio (PLR) and Lymphocyte-to C-reactive protein ratio (LCR) (P = 0.002), and C-reactive protein (CRP) levels (P < 0.001). Amongst the deceased patients, there was significant leukocytosis (P = 0.008), neutrophilia and lymphopenia (P < 0.001), increased NLR (P = 0.001), decreased LMR (P < 0.001), increased PLR (p = 0.017), decreased LCR (p = 0.003), and elevated CRP level (P < 0.001). A receiver operating characteristic curve obtained for the above parameters showed NLR (AUC: 0.841, PPV: 83.6%) and PLR (AUC: 0.703, PPV: 81.8%) for ICU patients, while NLR (AUC: 0.860, PPV: 91.1%) and PLR (AUC: 0.677, PPV: 87.5%) for the deceased patients had significant accuracy for predicting the disease severity of COVID-19 in comparison to survivors. Conclusion: The inflammatory markers and hematological indices are a good guide for predicting the severity and disease outcome of coronavirus disease. NLR and PLR are elevated in severe disease while LMR and LCR are inversely correlating with disease severity.

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“…The neutrophil to lymphocyte ratio has been used as an inflammatory index [45] and can be calculated from cell counts obtained from a routine full or complete blood count. Its use in the setting of sepsis has been suggested as being potentially most useful in low-or middle-income countries, as it does not require any extra specific analytical capability or cost outlay [46], although its diagnostic accuracy does seem to be limited [46][47][48] and well below that of CRP [48].…”

Section: Number Of Studiesmentioning

confidence: 99%

Biomarkers for Point-of-Care Diagnosis of Sepsis

2020

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Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In 2017, almost 50 million cases of sepsis were recorded worldwide and 11 million sepsis-related deaths were reported. Therefore, sepsis is the focus of intense research to better understand the complexities of sepsis response, particularly the twin underlying concepts of an initial hyper-immune response and a counter-immunological state of immunosuppression triggered by an invading pathogen. Diagnosis of sepsis remains a significant challenge. Prompt diagnosis is essential so that treatment can be instigated as early as possible to ensure the best outcome, as delay in treatment is associated with higher mortality. In order to address this diagnostic problem, use of a panel of biomarkers has been proposed as, due to the complexity of the sepsis response, no single marker is sufficient. This review provides background on the current understanding of sepsis in terms of its epidemiology, the evolution of the definition of sepsis, pathobiology and diagnosis and management. Candidate biomarkers of interest and how current and developing point-of-care testing approaches could be used to measure such biomarkers is discussed.

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Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study

Cited by 84 publications

References 39 publications

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

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

Biomarkers for Point-of-Care Diagnosis of Sepsis

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