Increased neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with severe sepsis or septic shock

Abstract There has been no study exploring the prognostic values of neutrophil percentage-to-albumin ratio (NPAR). We hypothesised that NPAR is a novel marker of inflammation and is associated with all-cause mortality in patients with severe sepsis or septic shock. Patient data were extracted from the MIMIC-III V1.4 database. Only the data for the first intensive care unit (ICU) admission of each patient were used and baseline data were extracted within 24 h after ICU admission. The clinical endpoints were 30-, 90- and 365-day all-cause mortality in critically ill patients with severe sepsis or septic shock. Cox proportional hazards models and subgroup analyses were used to determine the relationship between NPAR and these clinical endpoints. A total of 2166 patients were eligible for this analysis. In multivariate analysis, after adjustments for age, ethnicity and gender, higher NPAR was associated with increased risk of 30-, 90- and 365-day all-cause mortality in critically ill patients with severe sepsis or septic shock. Furthermore, after adjusting for more confounding factors, higher NPAR remained a significant predictor of all-cause mortality (tertile 3 vs. tertile 1: HR, 95% CI: 1.29, 1.04–1.61; 1.41, 1.16–1.72; 1.44, 1.21–1.71). A similar trend was observed in NPAR levels stratified by quartiles. Higher NPAR was associated with increased risk of all-cause mortality in critically ill patients with severe sepsis or septic shock.

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The Neutrophil Percentage-to-Albumin Ratio is Associated with All-Cause Mortality in Critically Ill Patients with Acute Myocardial Infarction

10.21203/rs.3.rs-877233/v1 ◽

2021 ◽

Author(s):

Ya Lin ◽

Yanhan Lin ◽

Juanqing Yue ◽

Qianqian Zou

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Information ◽

Cox Proportional Hazards ◽

Albumin Ratio ◽

Neutrophil Percentage ◽

Increased Risk ◽

All Cause Mortality

Abstract Aim In this study, we evaluated the utility of neutrophil percentage-to-albumin ratio (NPAR) in predicting in critically ill patients with acute myocardial infarction (AMI). Methods the information of patients were collected from Medical Information Mart for Intensive Care III (MIMIC III) database. Admission NPAR was calculated as neutrophil percentage divided by serum albumin. The endpoints of this study were 30-day, 90-day, 180-day, and 365-day all-cause mortality. Cox proportional hazards models and subgroup analyses were used to determine the relationship between admission NPAR and these endpoints. Results 798 critically ill patients with AMI were enrolled in. After adjustments for age, race and gender, higher admission NPAR was associated with increased risk of 30-day, 90-day, 180-day, and 365-day all-cause mortality in critically ill patients with AMI. And after adjusting for possible confounding variables, two different trends have emerged. Stratified by tertiles, high admission NPAR was independently associated with 180-day and 365-day all-cause mortality in critically ill patients with AMI (tertile 3 vs. tertile 1: adjusted HR, 95%CI: 1.71,1.10-2.66, p<0.05;1.66,1.10-2.51, p<0.05). In other hand, stratified by quartiles, highest admission NPAR levels were independently associated with 90-day, 180-day and 365-day all-cause mortality (quartile 4 vs. quartile 1: adjusted HR, 95% CI: 2.36,1.32-4.23, p<0.05; 2.58,1.49-4.47, p<0.05; 2.61,1.56-4.37, p<0.05). ROC test showed that admission NPAR had a moderate ability to predict all-cause mortality of critically ill patients with AMI. No obvious interaction was found by subgroup analysis in most subgroups. Conclusions admission NPAR was an independent predictor for 180-day and 365-day all-cause mortality in critically ill patients with AMI.

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The Neutrophil Percentage-to-Albumin Ratio Is Associated with All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury

BioMed Research International ◽

10.1155/2020/5687672 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Benji Wang ◽

Diwen Li ◽

Bihuan Cheng ◽

Binyu Ying ◽

Yuqiang Gong

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Proportional Hazards ◽

Kidney Injury ◽

Cox Proportional Hazards ◽

Albumin Ratio ◽

Neutrophil Percentage ◽

Increased Risk ◽

All Cause Mortality

Background. There is no evidence to suggest the predictive power of neutrophil percentage-to-albumin ratio (NPAR) in patients with acute kidney injury (AKI). We hypothesized that NPAR would correlate with all-cause mortality in critically ill patients with AKI. Methods. From the MIMIC-III V1.4 database, we extracted demographics, vital signs, comorbidities, laboratory tests, and other clinical data. The clinical endpoints were 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI. Cox proportional hazards models were used to evaluate the prognostic values of NPAR, and subgroup analyses were performed to measure mortality across various subgroups. Results. A total of 7,481 eligible subjects were enrolled. In multivariate analysis, after adjustments for age, ethnicity, gender, and other confounding factors, higher NPARs were associated with an increased risk of 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI (tertile 3 versus tertile 1: adjusted HR, 95% CI: 1.48, 1.30–1.69; 1.47, 1.31–1.66; 1.46, 1.32–1.62, respectively; P trend <0.01). A similar trend was observed in the NPAR group division by quintiles. Subgroup analysis revealed no significant interactions in most strata. Conclusions. Increased NPAR correlates with increased risk of all-cause mortality in critically ill patients with AKI.

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The Neutrophil Percentage-to-Albumin Ratio as a New Predictor of All-Cause Mortality in Patients with Cardiogenic Shock

BioMed Research International ◽

10.1155/2020/7458451 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Yue Yu ◽

Yu Liu ◽

Xinyu Ling ◽

Renhong Huang ◽

Suyu Wang ◽

...

Keyword(s):

Cardiogenic Shock ◽

Critically Ill ◽

Critically Ill Patients ◽

Cox Regression ◽

Albumin Ratio ◽

Group Iii ◽

Group I ◽

Neutrophil Percentage ◽

Increased Risk ◽

Wide Range

Background. Although the neutrophil percentage-to-albumin ratio (NPAR) has proven to be a robust systemic inflammation-based predictor of mortality in a wide range of diseases, the prognostic value of the NPAR in critically ill patients with cardiogenic shock (CS) remains unknown. This study aimed at investigating the association between the admission NPAR and clinical outcomes in CS patients using real-world data. Methods. Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included all-cause in-hospital, 30-day, and 365-day mortality in CS patients. First, the NPAR was analyzed as a continuous variable using restricted cubic spline Cox regression models. Second, X-tile analysis was used to calculate the optimal cut-off values for the NPAR and divide the cohort into three NPAR groups. Moreover, multivariable Cox regression analyses were used to assess the association of the NPAR groups with mortality. Results. A total of 891 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between the NPAR and in-hospital and 30-day mortality was observed (all P values for nonlinear trend<0.001). According to the optimal cut-off values by X-tile, NPARs were divided into three groups: group I ( NPAR < 25.3 ), group II ( 25.3 ≤ NPAR < 34.8 ), and group III ( 34.8 ≤ NPAR ). Multivariable Cox analysis showed that higher NPAR was independently associated with increased risk of in-hospital mortality (group III vs. group I: hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.72-3.92, P < 0.001 ), 30-day mortality (group III vs. group I: HR 2.42, 95% CI 1.65-3.54, P < 0.001 ), and 365-day mortality (group III vs. group I: HR 6.80, 95% CI 4.10-11.26, P < 0.001 ) in patients with CS. Conclusions. Admission NPAR was independently associated with in-hospital, 30-day, and 365-day mortality in critically ill patients with CS.

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Association between Neutrophil Percentage-to-Albumin Ratio and All-Cause Mortality in Critically Ill Patients with Coronary Artery Disease

BioMed Research International ◽

10.1155/2020/8137576 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Tienan Sun ◽

Hua Shen ◽

Qianyun Guo ◽

Jiaqi Yang ◽

Guangyao Zhai ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Critically Ill ◽

Critically Ill Patients ◽

Group Versus ◽

Independent Effect ◽

Albumin Ratio ◽

Neutrophil Percentage ◽

All Cause Mortality ◽

Artery Disease

Background. Neutrophil percentage-to-albumin ratio (NPAR) has been proved to be associated with clinical outcome of many diseases. This study was aimed at exploring the independent effect of NPAR on all-cause mortality of critically ill patients with coronary artery disease (CAD). Method. NPAR was calculated as neutrophil percentage numerator divided by serum albumin concentration. Clinical endpoints were 30-day, 90-day, and 365-day all-cause mortality. Multivariable Cox proportional hazard models were performed to confirm the association between NPAR and all-cause mortality. Result. 3106 patients with CAD were enrolled. All-cause mortality rates of 30 days (P<0.001), 90 days (P<0.001), and 365 days (P<0.001) increased as NPAR tertiles increased. And after adjusting for possible confounding variables, NPAR was still independently associated with 30-day (third tertile group versus first tertile group: HR, 95% CI: 1.924, 1.471-2.516; P for trend < 0.001), 90-day (third tertile group versus first tertile group: HR, 95% CI: 2.053, 1.646-2.560; P for trend < 0.001), and 365-day (third tertile group versus first tertile group: HR, 95% CI: 2.063, 1.717-2.480; P for trend < 0.001) all-cause mortality in patients with CAD. Subgroup analysis did not find obvious interaction in most subgroups. Conclusion. NPAR was independently correlated with 30-day, 60-day, and 365-day all-cause mortality in critically ill patients with CAD.

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Faculty Opinions recommendation of Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718312921.793493679 ◽

2014 ◽

Author(s):

Niranjan Kissoon ◽

Srinivas Murthy

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

New Zealand ◽

Critically Ill ◽

Critically Ill Patients ◽

Sepsis And Septic Shock

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Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽

10.1186/s13054-021-03540-6 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Eleni Papoutsi ◽

Vassilis G. Giannakoulis ◽

Eleni Xourgia ◽

Christina Routsi ◽

Anastasia Kotanidou ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Mortality And Morbidity ◽

Icu Admission ◽

All Cause Mortality ◽

Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

Microorganisms ◽

10.3390/microorganisms8020287 ◽

2020 ◽

Vol 8 (2) ◽

pp. 287 ◽

Cited By ~ 4

Author(s):

Georgios Papathanakos ◽

Ioannis Andrianopoulos ◽

Athanasios Papathanasiou ◽

Efthalia Priavali ◽

Despoina Koulenti ◽

...

Keyword(s):

Septic Shock ◽

Acinetobacter Baumannii ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Problem ◽

Hospital Infections ◽

Colistin Resistance ◽

Icu Patients ◽

Icu Admission ◽

Comorbidity Index

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

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Chronically critically ill patients: different behavior in severe sepsis and septic shock?

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a83 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

DH Prevedello ◽

A Rea-Neto ◽

HA Teive ◽

LA Tannous ◽

RAO Deucher ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Chronically Critically Ill ◽

Sepsis And Septic Shock

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Biomarker-assisted identification of sepsis-related acute liver impairment: a frequent and deadly condition in critically ill patients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-1350 ◽

2019 ◽

Vol 57 (9) ◽

pp. 1422-1431 ◽

Cited By ~ 1

Author(s):

Jens-Ulrik Stæhr Jensen ◽

Lars Peters ◽

Theis S. Itenov ◽

Morten Bestle ◽

Katrin M. Thormar ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Prognostic Impact ◽

Surgical Intensive Care ◽

Positive Interaction ◽

Liver Impairment ◽

Risk Of Death ◽

Increased Risk ◽

Co Morbidity ◽

All Cause Mortality

Abstract Background The prognostic impact of mild/moderate liver impairment among critically ill patients is not known. We aimed to determine whether acute liver impairment, as measured by several biomarkers, (i) is frequent, (ii) influences prognosis and (iii) to determine whether such an effect is specific for infected critically ill patients. Methods A biomarker and clinical cohort study based on a randomized controlled trial. All-cause mortality was the primary endpoint. Biomarkers hyaluronic acid (HA), bilirubin, albumin, alkaline phosphatase and the international normalized ratio (INR) were determined. Multivariable statistics were applied to estimate risk increase according to liver biomarker increase at baseline and the model was adjusted for age, APACHE II, severe sepsis/septic shock vs. milder infection, chronic alcohol abuse Charlson’s co-morbidity index, cancer disease, surgical or medical patient, body mass index, sex, estimated glomerular filtration rate, mechanical ventilation and the other biomarkers. Time-to-event graphs were used. The patients were critically ill patients (n = 1096) from nine mixed medical/surgical intensive care units without known hepatobiliary disease. Results HA levels differed between infected patients (median 210.8 ng/mL [IQR: 93.2–556.6]) vs. the non-infected (median 56.8 ng/mL [IQR: 31.9–116.8], p < 0.001). Serum HA quartiles 2, 3 and 4 were independent predictors of 90-day all-cause mortality for the entire population (infected and non-infected). However, the signal was driven by the infected patients (positive interaction test, no signal in non-infected patients). Among infected patients, HA quartiles corresponded directly to the 90-day risk of dying: 1st quartile: 57/192 = 29.7%, 2nd quartile: 84/194 = 43.3%, 3rd quartile: 90/193 = 46.6%, 4th quartile: 101/192 = 52.3 %, p for trend: <0.0001. This finding was confirmed in adjusted analyses: hazard ratio vs. 1st quartile: 2nd quartile: 1.3 [0.9–1.8], p = 0.14, 3rd quartile: 1.5 [1.1–2.2], p = 0.02, 4th quartile: 1.9 [1.3–2.6], p < 0.0001). High bilirubin was also an independent predictor of mortality. Conclusions Among infected critically ill patients, subtle liver impairment, (elevated HA and bilirubin), was associated with a progressive and highly increased risk of death for the patient; this was robust to adjustment for other predictors of mortality. HA can identify patients at high risk.

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