The Relationship Between Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios With Hospital Stays and Mortality in the Emergency Department

Cifci, Mustafa; Halhallı, Hüseyin Cahit

doi:10.7759/cureus.12179

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…Value of NLR above 8.5 was considered 78% sensitive and 70% specific for severe disease in the same study. Another study conducted on 557 patients concluded both NLR and PLR are associated with severity and mortality with equal sensitivity and specificity [ 4 ]. When the same markers were studied in the pregnant population, NLR was significantly elevated in acute pancreatitis, but there was no statistically significant difference in terms of PLR [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…This would result in timely and adequate treatment [1], as well as decreased rates of morbidity and mortality [2]. Not to mention the current overall mortality rate of acute pancreatitis is 2.1% increasing to 17% in severe acute pancreatitis [2,4]. In the past, various scoring systems have been suggested to assess the disease severity.…”

Section: Introductionmentioning

confidence: 99%

“…For the same purpose, many biochemical markers have also been assessed individually, such as C-reactive protein (CRP) and procalcitonin [ 1 ]. But mostly, these scoring systems require 48 hours to apply, and their complexity further results in limited use [ 3 , 4 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…This leads to immunological instability, which increases the severity of disease and mortality rate [ 7 , 8 ]. Recent data suggest that markers of systemic inflammation: neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are able to predict the prognosis of various diseases, including cancers [ 1 , 4 , 7 , 9 ]. In intensive care unit patients, it has been seen that high levels of NLR point towards poor prognosis and high mortality [ 7 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis

Khan¹,

Kazmi²,

Asghar³

et al. 2021

Cureus

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IntroductionAcute pancreatitis is defined as inflammation of the pancreas. The body responds to inflammation by producing excessive neutrophils and causing programmed cell death of lymphocytes. This leads to immunological instability, which increases the severity of the disease and mortality rate. Recent data suggest that markers of systemic inflammation are able to predict the prognosis of various diseases. Our study aims to assess the severity of acute pancreatitis in conjunction with these hematological markers of systemic inflammation. Materials and methodsOur study was carried out in the emergency medicine department of a tertiary care hospital among patients diagnosed with acute pancreatitis. It was a retrospective study done by reviewing the hospital's medical records. Hematological indices such as hemoglobin levels, packed cell volume (PCV), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), total leukocyte count (TLC), neutrophil count, lymphocyte count, monocyte count, platelet count, neutrophil to lymphocyte count ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR) were observed to be associated with severity of pancreatitis. Those with computed tomography (CT) severity score >=7 were termed as severe pancreatitis, while those below 7 were considered mild to moderate. ResultsA total of 154 patients were included in the final analysis. The mean age of those patients was 48.47 ± 16.71 years. There were 94 male and 60 female patients. There was no difference found among the study groups with respect to mean hemoglobin levels, RBC count, PCV, MCV, MCH, MCHC, lymphocytes, and platelet counts. TLC (p<0.001), neutrophils (p<0.001), monocytes (p=0.008), NLR (p<0.001), and PLR (p=0.006) were found higher in severe pancreatitis, while LMR was found lower in severe pancreatitis (p=0.003). A linear relationship between the hematological indices and CT severity score has shown that TLC (p=0.015), neutrophils (p=0.005), NLR (p=0.001), and PLR (p<0.001) were positively correlated with severity while lymphocyte count (p=0.004) and LMR (p=0.005) were negatively correlated with severe pancreatitis. TLC and LMR were independent predictors of severe pancreatitis with an adjusted odds ratio of 12.80 and 5.47, respectively, on multivariable regression analysis. ConclusionMany markers correlated with the CT severity score, but few of them were able to demonstrate statistical significance on receiver operating characteristic (ROC) analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis

Khan¹,

Kazmi²,

Asghar³

et al. 2021

Cureus

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“…Neutrophil-lymphocyte ratio, NLR. Даний показник може застосовуватись як з метою визначення важкості системної запальної відповіді, так і з метою прогнозування подальшого перебігу гострого панкреатиту [3][4][5][6]. У нормі значення показника НЛС варіюють від 0,78 до 3,53 [7].…”

Section: вступunclassified

Neutrophil-Lymphocyte Ratio as an Early Prognostic Predictor of the Course of Acute Pancreatitis

Formanchuk¹,

Shaprynskyi²,

Lopushanskiy³

2022

Khark. Surg. Sch.

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Summury. Introduction. One of the laboratory markers that can be used both to determine the severity of the systemic inflammatory response and to predict the further course of acute pancreatitis (AP) is the neutrophil-lymphocyte ratio (NLR). The aim of our work was to study the dynamics of changes in the NLR indicator on 1, 3 and 5 days after hospitalization in groups of patients with AP. Materials and methods: The data of 99 patients with AP of moderate severity and severe who were treated in the department of surgery and intensive care unit of the Vinnytsia city clinical emergency hospital for the period from January 2018 to December 2020 were analyzed. The diagnosis of AP was made based on the criteria of Atlanta, 2012. All patients were divided into two groups. The group of patients who survived consisted of 78 patients and 21 patients who died, respectively. NLR was calculated on the 1st, 3rd and 5th day after hospitalization of patients in a hospital in each group and the reliability of the difference of this indicator was evaluated. Results and discussion: The NLR on the day of hospitalization in the group of the dead did not differ significantly from the group of survivors and was (11,6±2,7) and (10,6±2,1), respectively (p>0,05). On the third day of hospital stay, despite infusion therapy, there was a significant increase in the NLR index in the group of the deceased to (13,8±4,6) and its decrease in the group of patients who survived to (6,8±2,3) (p<0,0001). On the fifth day of hospital stay, there was a decrease in the level of NLR in the group of the dead to (7,7±1,5), with a significant difference compared to the group of patients who survived — (7,0±1,7) (p<0,05). Conclusions: In this study, we did not find a significant difference in the NLR index on the 1st day of hospitalization in the groups of deceased patients with AP and surviving patients (p>0,05), however, we observed a sharp, significant increase in the NLR index on the 3rd day in the group of patients, who died compared to the group that survived (p<0,0001). On the 5th day after the hospitalization of the patients, against the background of the infusion therapy, a decrease in the NLR index was noted in both groups of patients to almost the same level, while maintaining a reliable difference between them (p<0,05).

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Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department

Galardo,

Crisanti,

Gentile

et al. 2024

Intern Emerg Med

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Early identification of patients with a poorer prognosis in the Emergency Department (ED) is crucial for prompt treatment and resource allocation. We investigated the relationship between the Neutrophil to Lymphocyte Ratio (NLR) and 30-day mortality in elderly acute medical patients. Prospective single-center cohort study including consecutive patients admitted to the ED. Inclusion criteria were age > 65 years and medical condition as the cause of ED access. Exclusion criteria were patients admitted for traumatic injuries or non-traumatic surgical diseases. ROC analysis was used to set the best cut-off of the NLR for mortality. 953 patients were included and 142 (14.9%) died during follow-up. ROC analysis showed a good predictive value of the NLR with an AUC 0.70, 95%CI 0.67–0.73 (p < 0.001) and identified a NLR > 8 as the best cut-off. Patients with NLR > 8 had a more serious triage code (72.6% had a triage code ≤ 2) and an increased heart rate and body temperature. They more often presented with dyspnea, abdominal pain, falls and vomiting. They also were characterized by an increase in urea, creatinine, white blood cells, neutrophils, fibrinogen, D-dimer, glycemia, CRP, LDH and transaminases and by a decrease in eGFR, of lymphocytes and monocytes. Multivariable logistic regression analysis demonstrated that the NLR remained associated with mortality after adjustment for confounders (Odds ratio 2.563, 95%CI 1.595–4.118, p < 0.001). Patients with NLR > 8 showed a higher mortality rate. NLR is an easy and inexpensive tool that may be used for risk stratification in the ED. The results of this study need to be validated in larger external cohorts.

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The Relationship Between Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios With Hospital Stays and Mortality in the Emergency Department

Cited by 7 publications

References 26 publications

Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis

Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis

Neutrophil-Lymphocyte Ratio as an Early Prognostic Predictor of the Course of Acute Pancreatitis

Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department

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