The ability of Procalcitonin, lactate, white blood cell count and neutrophil-lymphocyte count ratio to predict blood stream infection. Analysis of a large database

Marik, Paul E.; Stephenson, Elise

doi:10.1016/j.jcrc.2020.07.026

Cited by 43 publications

(38 citation statements)

References 38 publications

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“…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][22][23][24]. Most of the above-mentioned studies showed these associations to be of prognostic value as well [21,[23][24].…”

Section: Discussionsupporting

confidence: 90%

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: 90%

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Rehman¹,

Khan²,

Aziz³

et al. 2020

Cureus

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“…At presentation in the ED, scores based on clinical parameters and/or bedside biomarkers are the most rapid way of classifying the risk of BSI and/or sepsis can be used to guide both diagnostic activities and initial treatment decisions. The use of NLCR in the prediction of positive blood culture have been studied previously with reported AUC values of 0.68-0.77 [20][21][22]29] consistent with our results (0.74 (0.69-0.78)). No consensus regarding use of cut-off level has been reached.…”

Section: Discussionsupporting

confidence: 92%

“…In a retrospective study by Turak et al, 121 patients with infective endocarditis (mostly caused by Gram-positive pathogens) had low NLCR at admission (7.3 ± 3.0) [33] making an NLCR cut-off at 12 less suitable in these cases. In a recent study by Marik et al Gram-negative BSI rendered higher NLCR values compared to Gram positive BSI (17.3 vs 12.5) [29]. This together with the results presented here indicates that NLCR predicts Gram-negative BSI better than Gram-positive BSI but this still needs to be evaluated in larger materials.…”

Section: Discussionsupporting

confidence: 73%

“…However, the relative complexity of using different cut-offs depending on Sepsis-3 status (requiring prior calculation of SOFA-score) warrants the use of the same cut-off value (Shapiro≥3 or NLCR> 12) irrespective of sepsis status in an ED setting. CRP and serum lactate was considered not suitable as predictors of BSI due to significantly lower AUC values, consistent with earlier studies [9,11,29], and were therefore not further evaluated. Elevated levels of CRP and lactate are likely too nonspecific indicators of inflammation and hypoxia/critical illness to be useful in the prediction of positive blood culture.…”

Section: Discussionmentioning

confidence: 58%

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Early prediction of blood stream infection in a prospectively collected cohort

et al. 2021

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Background Blood stream infection (BSI) and sepsis are serious clinical conditions and identification of the disease-causing pathogen is important for patient management. The RISE (Rapid Identification of SEpsis) study was carried out to collect a cohort allowing high-quality studies on different aspects of BSI and sepsis. The aim of this study was to identify patients at high risk for BSI who might benefit most from new, faster, etiological testing using neutrophil to lymphocyte count ratio (NLCR) and Shapiro score. Methods Adult patients (≥ 18 years) presenting at the emergency department (ED) with suspected BSI were prospectively included between 2014 and 2016 at Örebro University Hospital. Besides extra blood sampling, all study patients were treated according to ED routines. Electronic patient charts were retrospectively reviewed. A modified Shapiro score (MSS) and NLCR were extracted and compiled. Continuous score variables were analysed with area under receiver operator characteristics curves (AUC) to evaluate the ability of BSI prediction. Results The final cohort consisted of 484 patients where 84 (17%) had positive blood culture judged clinically significant. At optimal cut-offs, MSS (≥3 points) and NLCR (> 12) showed equal ability to predict BSI in the whole cohort (AUC 0.71/0.74; sensitivity 69%/67%; specificity 64%/68% respectively) and in a subgroup of 155 patients fulfilling Sepsis-3 criteria (AUC 0.71/0.66; sensitivity 81%/65%; specificity 46%/57% respectively). In BSI cases only predicted by NLCR> 12 the abundance of Gram-negative to Gram-positive pathogens (n = 13 to n = 4) differed significantly from those only predicted by MSS ≥3 p (n = 7 to n = 12 respectively) (p < 0.05). Conclusions MSS and NLCR predicted BSI in the RISE cohort with similar cut-offs as shown in previous studies. Combining the MSS and NLCR did not increase the predictive performance. Differences in BSI prediction between MSS and NLCR regarding etiology need further evaluation.

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“…The dynamic changes in NLR in the fi rst 3-5 days are crucial for the prognosis and outcome in ICU patients (Sari et al, 2019). A recent research on biomarkers of sepsis confi rmed that reliable and valid biomarkers used for the diagnosis, monitoring and stratifi cation of sepsis, systemic infection and SIRS include IL-6, NLR, procalcitonin, C-reactive protein and lactate (Ljungstrom et al, 2017, Marik et al, 2020.…”

Section: Nlr In Sepsis Systemic Infl Ammation and Sirsmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio, past, present and future perspectives

Záhorec¹

2021

BLL

357

286

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In the review we analyzed short history of the establishment of a novel hematological parameter for systemic infl ammation and stress coined as a neutrophil to lymphocyte ratio (NLR). Today NLR is widely used across almost all medical disciplines as a reliable and easy available marker of immune response to various infectious and non-infectious stimuli. We analyzed the immunological and biological aspects of dynamic changes of neutrophil granulocytes and lymphocytes in circulating blood during endocrine stress, dysbalance of autonomic nervous system and systemic infl ammation. NLR refl ects online dynamic relationship between innate (neutrophils) and adaptive cellular immune response (lymphocytes) during illness and various pathological states. NLR is infl uenced by many conditions including age, rice, medication, chronic disease like coronary heart disease, stroke, diabetes, obesity, psychiatric diagnosis, cancer of solid organs, anemia and stress. A normal range of NLR is between 1-2, the values higher than 3.0 and below 0.7 in adults are pathological. NLR in a grey zone between 2.3-3.0 may serve as early warning of pathological state or process such like cancer, atherosclerosis, infection, infl ammation, psychiatric disorders and stress. NLR is used as a reliable and cheap marker of ongoing cancerrelated infl ammation and a valid indicator of prognosis of solid tumors. Majority of meta-analyses have explored the prognostic value of NLR in various solid tumors and have found out the cut-off value of NLR above 3.0 (IQR 2.5-5.0). We summarized its privilege in oncology: NLR may be used for stratifi cation of cancer, correlates with the tumor size, stage of tumors, metastatic potential and lymphatic invasion. NLR has independent prognostic role regarding overall, cancer free and cancer-specifi c survival. It is useful for monitoring oncological therapy, including biological and immune check point inhibitors treatment. NLR is a very sensitive indicator of infection, infl ammation and sepsis, validated in numerous studies. Clinical research confi rmed the sensitivity of NLR for diagnosis/stratifi cation of systemic infection, sepsis, bacteremia as well as its robust predictive and prognostic value. NLR should be investigated daily, and follow-up its absolute values and dynamic course in acute disease or critical illness. The severity of critical illness, the level of stress and serious infl ammation is expressed by dramatic increasing of NLR values above 11 ≥ 17, or even higher than 30. Improving the clinical course of sepsis, critical illness, lower risk of mortality are associated with decline of NLR values below 7. NLR is helpful in differentiating more severe disease versus milder one. NLR is cheap, simple, fast responding and easy available parameter of stress and infl ammation with high sensitivity and low specifi city, it should be used routinely in emergency departments, ICUs, in acute medicine including surgery, orthopedics, traumatology, cardiology, neurology, psychiatry and even oncology. Dynamic changes ...

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The ability of Procalcitonin, lactate, white blood cell count and neutrophil-lymphocyte count ratio to predict blood stream infection. Analysis of a large database

Cited by 43 publications

References 38 publications

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Early prediction of blood stream infection in a prospectively collected cohort

Neutrophil-to-lymphocyte ratio, past, present and future perspectives

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