The role of neutrophil/lymphocyte ratio in predicting the severity of sepsis in a tertiary care hospital in South India: a retrospective study

Abstract

Background: Sepsis, a syndrome of dysregulated host response to infection leading to life-threatening organ dysfunction, is having a substantial burden in health system. The outcome in sepsis is often time dependent. None of the clinical manifestations nor the age-old markers like ESR, CRP, etc. have proven diagnostic or prognostic of sepsis. This study aims to assess the role of neutrophil: lymphocyte ratio (NLR) in assessing the severity of sepsis within the initial 24 hrs of admission. Methods: Authors did a retrospective observational study in 208 sepsis patients admitted in the MDICU. The NLR was calculated and the study population was grouped into those with an NLR of more than or equal to 5 and those with less than 5. The patients were also grouped based on the number of organs impaired due to sepsis. The association between these groups were then assessed. Results: 46 patients (60.5%) with single organ involvement had NLR <5; 30 patients (39.5%) had NLR >5; 27 patients (42.2%) with two organ involvement had NLR <5 and 37 patients (57.8%) had NLR >5. Among patients with more than two organ involvement, 8 patients (21.6%) had NLR <5 and 29 patients (78.4%) had NLR >5. It was found that there is statistically significant association between increase in number of organs involved and NLR more than 5. The chi square test value was 15.691 with a p value was less than 0.001. Conclusions: In the current study, we have evaluated the role of NLR in sepsis. NLR calculated on the day of admission is a simple parameter that helps to stratify patients into severe risk category. A significant association was found with higher NLR and the number of organs impairment in sepsis.

Is Neutrophil–Lymphocyte Count Ratio a Better Indicator of Sepsis with Gram-positive Bacterial Infection?

“…In the study conducted by George et al, 78.4% of sepsis patients with NLCR score >5 were associated with more than two organ dysfunctions. 19 Rehman et al, in their study, stated that NLCR is comparable with other sepsis biomarkers (CRP, procalcitonin, and sequential organ failure assessment score) as a marker of disease severity. 20 Hence, a higher NLCR score can be used to initiate robust empirical therapy in patients with sepsis.…”

The Prognostic Role of Neutrophil-Lymphocyte Ratio in Fournier Gangrene Patients

“…They discovered that there most septic patients with MODS had a high NLR. The ratio is deemed superior to a white blood cell count [26] . A study with a large sample size by Li et al in 2016 also showed the predictive capability of NLR in septic patients [27] .…”

The Contribution of Procalcitonin, C-Reactive Protein and Interleukin-6 in the Diagnosis and Prognosis of Surgical Sepsis: An Observational and Statistical Study

“… 5–8 The increase in the concentration of these biomarkers can suggest the occurrence of sepsis and the clinicians will be able to initiate the appropriate and early treatment and thus the mortality in sepsis could be significantly reduced. 9 …”

“…[5][6][7][8] The increase in the concentration of these biomarkers can suggest the occurrence of sepsis and the clinicians will be able to initiate the appropriate and early treatment and thus the mortality in sepsis could be significantly reduced. 9 PCT is the most frequently investigated biomarker of sepsis and has demonstrated the best reliability in early diagnosis, especially for the detection of bacterial infections, compared to other inflammatory biomarkers. 10,11 However, many studies recommend the association of PCT with other inflammatory biomarkers for increasing the reliability in early diagnosis.…”