1. bookVolume 28 (2020): Issue 1 (January 2020)
Journal Details
License
Format
Journal
eISSN
2284-5623
First Published
08 Aug 2013
Publication timeframe
4 times per year
Languages
English
access type Open Access

The usefulness of neutrophil/lymphocyte count ratio in the diagnosis and prognosis of bacterial sepsis – An old parameter with new implications

Published Online: 07 Feb 2020
Volume & Issue: Volume 28 (2020) - Issue 1 (January 2020)
Page range: 39 - 48
Received: 11 Jul 2019
Accepted: 03 Nov 2019
Journal Details
License
Format
Journal
eISSN
2284-5623
First Published
08 Aug 2013
Publication timeframe
4 times per year
Languages
English
Abstract

Aims: To analyze the diagnostic role of neutrophil/lymphocyte count ratio (NLCR) in sepsis and to evaluate its usefulness in appreciating the prognosis of septic patients.

Methods : A prospective analysis of patients diagnosed with sepsis between October 2015 and July 2017 was performed. A control group of patients with systemic inflammatory response syndrome (SIRS) with noninfectious causes was recruited. The sensitivity, specificity and AUC of NCLR for sepsis diagnosis were comparatively assessed with other biomarkers including fibrinogen (FIB), C-reactive protein (CRP) and procalcitonin (PCT). The baseline levels of NLCR were correlated with APACHE IV, APS and SOFA scores of severity.

Results : We enrolled 105 patients with sepsis and 37 patients with noninfectious SIRS. NLCR had significantly higher levels in the first group (p---lt---0.05). For an optimal cut-off value of 8.18, the sensitivity, specificity and AUC of NLCR for sepsis diagnosis were 70.5%, 72.2% and 0.766, respectively. A cut-off value of 12.0 led to moderate sensitivity (58.7%) and moderate-to-high specificity (89%). For patients with SOFA score over 2 points, the characteristics did not significantly improve. The correlations between baseline NCLR and the severity scores were not statistically significant.

Conclusion : NLCR levels were significantly higher in sepsis group compared to noninfectious SIRS group. NLCR had moderate sensitivity and specificity regarding sepsis diagnosis. Baseline levels of NLCR did not correlate with the severity scores, so its usefulness in sepsis prognosis was limited.

Keywords

1. Hajj J, Blaine N, Salavaci J, Jacoby D. The „Centrality of Sepsis”: A Review on Incidence, Mortality, and Cost of Care. Healthcare (Basel). 2018;6(3):90. DOI: 10.3390/healthcare603009010.3390/healthcare6030090616472330061497Search in Google Scholar

2. Zhang HB, Chen J, Lan QF, Ma XJ, Zhang SY. Diagnostic values of red cell distribution width, platelet distribution width and neutrophil-lymphocyte count ratio for sepsis. Exp Ther Med. 2016;12(4):2215-9. DOI: 10.3892/etm.2016.358310.3892/etm.2016.3583503836427698714Search in Google Scholar

3. Kaushik R, Gupta M, Sharma M, Jash D, Jain N, Sinha N, et al. Diagnostic and Prognostic Role of Neutro-phil-to-Lymphocyte Ratio in Early and Late Phase of Sepsis. Indian J Crit Care Med. 2018;22(9):660-3. DOI: 10.4103/ijccm.IJCCM_59_1810.4103/ijccm.IJCCM_59_18616158530294133Search in Google Scholar

4. Pantzaris ND, Platanaki C, Pierrako C, Karamouzos V, Velissaris D. Neutrophil-to-lymphocyte Ratio Relation to Sepsis Severity Scores and Inflammatory Biomarkers in Patients with Community-acquired Pneumonia: A Case Series. J Transl Int Med. 2018;6(1):43-6. DOI: 10.2478/jtim-2018-000910.2478/jtim-2018-0009587448729607304Search in Google Scholar

5. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102:653-7. DOI: 10.1016/j.amjcard.2008.05.00610.1016/j.amjcard.2008.05.00618773982Search in Google Scholar

6. Yang Z, Zhang Z, Lin F, Ren Y, Liu D, Zhong R, Liang Y. Comparisons of neutrophil-, monocyte-, eosinophil-, and basophil- lymphocyte ratios among various systemic autoimmune rheumatic diseases. APMIS. 2017;125(10):863-71. DOI: 10.1111/apm.1272210.1111/apm.1272228766758Search in Google Scholar

7. Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Oca-a A, et al. Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Solid Tumors: A Systematic Review and Meta-Analysis. J Natl Cancer Inst 2014;106(6):124. DOI: 10.1093/jnci/dju12410.1093/jnci/dju12424875653Search in Google Scholar

8. Riché F, Gayat E, Barthélémy R, Le Dorze M, Matéo J, Payen D. Reversal of neutrophil-to-lymphocyte count ratio in early versus late death from septic shock. Crit Care. 2015;19:439. DOI: 10.1186/s13054-015-1144-x10.1186/s13054-015-1144-x469933226671018Search in Google Scholar

9. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10. DOI: 10.1001/jama.2016.028710.1001/jama.2016.0287496857426903338Search in Google Scholar

10. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;4:1250-6. DOI: 10.1097/01. CCM.0000050454.01978.3B10.1097/01Search in Google Scholar

11. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20(6):864-74. DOI: 10.1097/00003246-199206000-0002510.1097/00003246-199206000-00025Search in Google Scholar

12. Ljungstrőm L, Pernestig AK, Jacobsson G, Andersson R, Usener B, Tilevik D. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PLoS ONE. 2017;12(7):e0181704. DOI: 10.1371/journal.pone.018170410.1371/journal.pone.0181704551918228727802Search in Google Scholar

13. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.Search in Google Scholar

14. Terradas R, Grau S, Blanch J, Riu M, Saballs P, Cas-tells X, et al. Eosinophil Count and Neutrophil-Lymphocyte Count Ratio as Prognostic Markers in Patients with Bacteremia: A Retrospective Cohort Study. PLoS ONE. 2012;7(8):e42860. DOI: 10.1371/journal. pone.0042860Search in Google Scholar

15. Orfanu A, Arama V, Arama SS, Leustean A, Catana R, Negru A, et al. The diagnostic and prognostic role of Neutrophil to Lymphocyte count ratio in sepsis. BMC Infect Dis. 2016;16(4):31-76.Search in Google Scholar

16. Velissaris D, Pantzaris ND, Bountouris P, Gogos C. Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients. Rom J Intern Med. 2018;56(3):153-7. DOI: 10.2478/rjim-2018-000510.2478/rjim-2018-000529427556Search in Google Scholar

17. Salciccioli JD, Marshall DC, Pimentel MA, Santos MD, Pollard T, Celi LA, et al. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care. 2015;19:13. DOI: 10.1186/s13054-014-0731-610.1186/s13054-014-0731-6434473625598149Search in Google Scholar

18. Okashah AS, El-Sawy MM, Beshay BN, Abd El-Raouf A. Ratio of Neutrophil to Lymphocyte counts as a simple marker for sepsis and severe sepsis in Intensive Care Unit. Res Opin Anesth Intensive Care. 2014;2:39-45.Search in Google Scholar

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