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

Abstract

Background/aim: While C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis, it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsis patients in the intensive care unit (ICU). Materials and methods:In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic health evaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data, antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve (AUC) were calculated for the inflammatory markers and ICU severity scores for mortality. Results:Of the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock, 330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR and CRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patients when compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality odds ratio was 6.96 (CI: 1.4-34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78, respectively) showed a similar increasing trend for mortality. Conclusion:The NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLR is >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

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

“…Globally, high mortality is reported due to sepsis that lies from 25% to 30%, while locally it ranges from 36% to 76% [ 8 - 9 ]. This makes sepsis an “emergency” and requires urgent care, recognition, and management within hours [ 7 - 10 ]. NLR (neutrophils to lymphocytes ratio) has been studied in the pediatric population with sepsis and has gained importance in being effective markers of disease activity.…”

Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis

“…COVID-19 severity is primarily affected by the innate inflammatory response of the body, where more severe cases were attributed to cytokine storm, a condition when there is an excessive immune response [ 51 ]. NLR is a known indicator of systemic inflammation that has been widely used for many conditions, such as predicting in-hospital mortality in sepsis patients, outcomes in cardiovascular diseases, and poor prognosis and higher ICU admissions in acute pancreatitis [ [52] , [53] , [54] , [55] ]. The biological mechanism underlying this association is that high NLR indicates an imbalance in the inflammatory response, which resulted from increased neutrophil and decreased lymphocyte counts.…”

Neutrophil-to-Lymphocyte Ratios Are Closely Associated With the Severity and Course of Non-mild COVID-19

“…Currently, N/LRs are a well-known marker of systemic inflammation and infection, and they have been studied as predictors of bacterial infection, showing superior predictive value over conventional inflammatory markers ( 22 – 24 ). In addition, the N/LRs have displayed good predictive power for pneumonia, as well as dose-response information relating to the burden of community-acquired pneumonia, such as pneumonia severity or mortality ( 25 , 26 ).…”