Neutrophil-to-lymphocyte count ratio in predicting prognosis of septic shock patients

Abstract Background Septic shock is one of the most common causes of admission to the intensive care unit in the world and one of the most common causes of death among intensive care patients. Since the definition of sepsis and septic shock and many studies have been designed to understand everything about sepsis regarding mechanism, pathophysiology, complications, diagnosis, management and all other aspects. Objective To find the association between neutrophil to lymphocyte count ratio and the mortality from septic shock patients. The work aims also to determine if this ratio can be used as a prognostic marker of septic shock patients and to compare this ratio with other sepsis markers as C-reactive protein (CRP) and procalcitonin. Patients and Methods This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 125 patients between January 2018 to January 2019. The ethics committee of our institution approved the study protocol, and written informed consent was obtained from each patient’s family. Results In our study, the neutrophils count was significantly increased in survived patients compared with early and late mortality patients in day 1 while lymphocytes count was lower in survived patient than early and late mortality patients and the NLCR in our study was higher in survived patients than early and late mortality patients. In day 4, our results revealed significant increase in neutrophils count in patients of late mortality compared with its count in survived patients, while lymphocytes didn't show any significant difference compared with its count in survived patients with significant increase in NLCR in patients of late mortality compared with those of survived patients in day 4. Both CRP and procalcitonin are increased in patients of early and late mortality groups compared with its value in survived patients in day 1 and 4. Conclusion This study demonstrates a real relationship between the NLCR and the risk of death in septic shock patients. Septic shock patients at risk of early death presented a low NLCR at admission, although late death was associated with an increased NLCR during the first 5 days. Early and late death should be distinguished because they may involve different underlying mechanisms, and the NLCR might be considered as a discriminant indicator of early or late death. In addition, our findings provide more insight into biology. The circulating neutrophil and lymphocyte trends observed in this study offer an interesting mechanistic viewpoint. We observed that circulating lymphocytes and the NLCR behave in opposite ways in early- and late death patients, supporting the hypothesis that divergent mechanisms could be involved in these two groups.

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Reversal of neutrophil-to-lymphocyte count ratio in early versus late death from septic shock

Critical Care ◽

10.1186/s13054-015-1144-x ◽

2015 ◽

Vol 19 (1) ◽

Cited By ~ 29

Author(s):

Florence Riché ◽

Etienne Gayat ◽

Romain Barthélémy ◽

Matthieu Le Dorze ◽

Joaquim Matéo ◽

...

Keyword(s):

Septic Shock ◽

Lymphocyte Count ◽

Late Death ◽

Count Ratio

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Neutrophil-Lymphocyte count ratio on admission as a predictor of Bacteremia and In Hospital Mortality among Sepsis and Septic shock In Patients at Rizal Medical Center

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i3.19030 ◽

2018 ◽

Vol 9 (3) ◽

pp. 36-40 ◽

Cited By ~ 1

Author(s):

Rakesh Kumar Mandal ◽

Primo B. Valenzuela

Keyword(s):

Septic Shock ◽

Hospital Mortality ◽

Lymphocyte Count ◽

Medical Center ◽

Laboratory Data ◽

Positive Association ◽

Cross Sectional ◽

Clinical Prognosis ◽

Count Ratio ◽

Sepsis And Septic Shock

Background: Neutrophil-Lymphocyte count ratio (NLCR), a readily accessible biomarker, has become increasingly useful as predictive and prognostic tools in patients with various medical conditions. NLCR has also been reported to represent disease severity effectively.Aims and Objectives: To investigate NLCR on admission as a prognostic marker of bacteremia and in-hospital mortality in patients diagnosed with Sepsis and Septic Shock.Materials and Methods: This cross-sectional, retrospective study involves one-hundred twenty (120) adult patients with Sepsis and Septic Shock admitted to the IMCU and ICU from January 2015 to December 2016. Laboratory data and clinical outcomes were retrieved and documented from the laboratory and patients’ charts. A cut-off point of >10 was used to be a marker for bacteremia and hence, patients were stratified into two groups based on this cut-off. Out of 120, 78 patients (with mean age of 60) has NLCR of at least 10 while only 42 patients (with mean age of 55) has NCLR of at most 10.Results: A significant, strong and positive association between NLCR and in-hospital mortality was found (P=0.0001) indicating that an increased rate of mortality is observed for patients with persistently high NCLR. Results also indicated that NLCR is a significant predictor (P=0.0002) of in-hospital mortality via a logistic model. The receiver-operating characteristic (ROC) curve for NLCR predicting in-hospital mortality showed an area under the curve (AUC) of 0.8007 which is an indicative of high predictive power. Its sensitivity and specificity is calculated to be 97.37% and 93.18, respectively. Overall, the performance of NCLR as a predictor based on its computed hit rate is found to be approximately 93.33%.Conclusion: Increased NLCR levels were independently associated with unfavorable clinical prognosis in patients with sepsis. A high NLCR (>10) is significantly associated with in- hospital mortality. NCLR predicts in-hospital mortality with high accuracy, high precision and small misclassification.Asian Journal of Medical Sciences Vol.9(3) 2018 6-9

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LIMFOSIT T CD4+SEBAGAI PERAMAL PERJALANAN PENYAKIT PASIEN YANG MENGALAMI SEPSIS

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v19i3.418 ◽

2016 ◽

Vol 19 (3) ◽

pp. 178

Author(s):

Lestari Ekowati ◽

Aryati Aryati ◽

Hardiono Hardiono

Keyword(s):

Septic Shock ◽

T Lymphocyte ◽

Roc Curve ◽

Lymphocyte Count ◽

Apache Ii Score ◽

Icu Mortality ◽

Survival Group ◽

Common Cause ◽

Significant Difference ◽

Very High

Sepsis is the most common cause of ICU mortality in USA. Mortality of sepsis in developing countries is still very high, about 50- 70% and has became a 80% incidence in septic shock. There was a decrease of CD4+ T lymphocyte count in patients with sepsis caused by apoptosis indicating septic patients suffered from immune functional impairment. CD4+ T lymphocyte count can reflect the severity of sepsis and predict the prognosis of the patients with sepsis effectively. Eighty eight (88) patients who met sepsis criteria were studied. The researchers collected clinical variables of all patients within 24 hours diagnosis of sepsis, and calculated APACHE II score. At the same time, blood sample were taken to measure the CD4+ T lymphocyte count. The data were analyzed using independent Student-T-test and ROC curve was used for prognosis. There is a significant difference in CD4+ T lymphocyte count between non survival and survival group (non survival group 203±178 cells/μL, survival group 442±303 cells/μL, p<0.001), and the percentage of CD4+ T lymphocyte (non survival group 25.05±11.55%, survival group 34.38±9.15%, p<0.001). There is an under ROC curve for CD4+ T lymphocyte count was 0.81, and for the percentage of CD4+ T lymphocyte was 0.748. Cut off value for CD4+ T lymphocyte count was 204 cells/μL, and the percentage of CD4+ T lymphocytes was 25.23%. Based on this study, the CD4+ T lymphocyte count can be used as a predictor of prognosis in sepsis patients.

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Dynamic changes of D-Dimer and Neutrophil-Lymphocyte Count Ratio as prognostic biomarkers in COVID-19

10.21203/rs.3.rs-21984/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Wenjing Ye ◽

Guoxi Chen ◽

Xiaopan Li ◽

Xing Lan ◽

Chen Ji ◽

...

Keyword(s):

Regression Analysis ◽

Lymphocyte Count ◽

Cox Regression ◽

Roc Curves ◽

Critical Value ◽

Dynamic Changes ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Count Ratio ◽

D Dimer

Abstract Background Since December 2019, the outbreak of COVID-19 caused a large number of hospital admissions in China. Many patients with COVID-19 have symptoms of acute respiratory distress syndrome, even are in danger of death. This is the first study to evaluate dynamic changes of D-Dimer and Neutrophil-Lymphocyte Count Ratio (NLR) as a prognostic utility in patients with COVID-19 for clinical use.Methods In a retrospective study, we collected data from 349 hospitalized patients who diagnosed as the infection of the COVID-19 in Wuhan Pulmonary Hospital. We used ROC curves and Cox regression analysis to explore critical value (optimal cut-off point associated with Youden index) and prognostic role of dynamic changes of D-Dimer and NLR.Results 349 participants were enrolled in this study and the mortality rate of the patients with laboratory diagnosed COVID-19 was 14.9%. The initial and peak value of D-Dimer and NLR in deceased patients were higher statistically compared with survivors (P<0.001). There was a more significant upward trend of D-Dimer and NLR during hospitalization in the deceased patients, initial D-Dimer and NLR were lower than the peak tests (MD) -25.23, 95% CI:-31.81- -18.64, P <0.001; (MD) -43.73, 95% CI:-59.28- -31.17, P <0.001. The test showed a stronger correlation between hospitalization days, PCT and peak D-Dimer than initial D-Dimer. The areas under the ROC curves of peak D-Dimer and peak NLR tests were higher than the initial tests (0.94(95%CI: 0.90-0.98) vs. 0.80 (95% CI: 0.73-0.87); 0.93 (95%CI:0.90-0.96) vs. 0.86 (95%CI:0.82-0.91). The critical value of initial D-Dimer, peak D-Dimer, initial NLR and peak NLR was 0.73 mg/L, 3.78 mg/L,7.13 and 14.31 respectively. The multivariable Cox regression analysis showed that age (HR 1.04, 95% CI 1.00-1.07, P=0.01), the peak D-Dimer (HR 1.03, 95% CI 1.01-1.04, P<0.001) were prognostic factors for COVID-19 patients’ death.Conclusions To dynamically observe the ratio of D-Dimer and NLR was more valuable during the prognosis of COVID-19. The rising trend in D-Dimer and NLR, or the test results higher than the critical values may indicate a risk of death for participants with COVID-19.

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Nosocomial Infection After Septic Shock Among Intensive Care Unit Patients

Infection Control and Hospital Epidemiology ◽

10.1086/591859 ◽

2008 ◽

Vol 29 (11) ◽

pp. 1054-1065 ◽

Cited By ~ 33

Author(s):

Caroline Landelle ◽

Alain Lepape ◽

Adrien Français ◽

Eve Tognet ◽

Hélène Thizy ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Nosocomial Infection ◽

Initial Phase ◽

Pulmonary Infection ◽

University Hospital ◽

Icu Patients ◽

Significant Difference ◽

The Impact

Objectives.To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.Design.Prospective cohort study.Setting.TWO intensive care units (ICUs) of a French university hospital.Patients and Methods.The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.Results.Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P = .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P = .03).Conclusions.The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.

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Evaluation of eosinophil count and neutrophil-lymphocyte count ratio versus C-reactive protein levels in patients with sepsis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174686 ◽

2017 ◽

Vol 5 (11) ◽

pp. 4754

Author(s):

Rahul Khajuria ◽

Vinu Jamwal ◽

Anil K. Gupta ◽

Abhinav Gupta

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Critically Ill Patients ◽

Eosinophil Count ◽

Lymphocyte Count ◽

Sepsis Group ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Count Ratio

Background: One major problem encountered in the intensive care unit is differentiating the inflammatory response from an infective process. Clinical and standard laboratory tests are not very helpful because most critically ill patients develop some degree of inflammatory response, whether or not they have sepsis. Numerous biomarkers have been evaluated to predict mortality in critically ill patients, although none have proved entirely useful. Objective of the study was to evaluate eosinophil count and neutrophil-lymphocyte count ratio with C-reactive protein levels in patients with sepsis.Methods: 71 patients >18 years of age of either sex with a diagnosis of sepsis were enrolled in this one-year observational study. Patients were classified according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine into sepsis group (n=50) and no sepsis group (n=21). Sepsis group were further divided into subgroups: sepsis (n=19), severe sepsis (n=16) and septic shock (n=15). Absolute eosinophil cell, neutrophil and lymphocyte counts for first 4 consecutive days and then on alternate days up to one week were also noted down. C-reactive protein levels on day 3 were also noted down.Results: In the sepsis group, mean eosinophil count was significantly (p<0.0001) low, mean neutrophil/lymphocyte count ratio was significantly (p<0.0001) high, mean CRP count was significantly (p=0.019) more as compared to that of no sepsis group. Among 16 mortalities, significant (p<0.05) decrease was noted in mean eosinophil count from day 3 onwards in patients of sepsis and septic shock subgroups. Mean N/L ratio showed no significant difference in patients of sepsis, severe sepsis or septic shock. Mean CRP count showed significant (p<0.05) increase in severe sepsis patients and mean Apache II score showed significant (p<0.05) deterioration in patients of septic shock.Conclusions: Neutrophil/lymphocyte count ratio (NLCR) and absolute eosinophil count (AEC) came out as better independent biomarker of sepsis in critically ill patients with infection admitted in intensive care unit. Diagnostic performance was better in these two diagnostic markers as compared to CRP marker. NLCR presented with sensitivity of 89.58%, AEC with 82.35% and CRP with 80.77%. Outcomes of NLCR and AEC were quick, easy and economical in establishing diagnosis of sepsis.

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Dynamic changes of D-Dimer and Neutrophil-Lymphocyte Count Ratio as prognostic biomarkers in COVID-19

10.21203/rs.3.rs-21984/v2 ◽

2020 ◽

Author(s):

Wenjing Ye ◽

Guoxi Chen ◽

Xiaopan Li ◽

Xing Lan ◽

Chen Ji ◽

...

Keyword(s):

Regression Analysis ◽

Lymphocyte Count ◽

Cox Regression ◽

Roc Curves ◽

Critical Value ◽

Dynamic Changes ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Count Ratio ◽

D Dimer

Abstract Background Since December 2019, the outbreak of COVID-19 caused a large number of hospital admissions in China. Many patients with COVID-19 have symptoms of acute respiratory distress syndrome, even are in danger of death. This is the first study to evaluate dynamic changes of D-Dimer and Neutrophil-Lymphocyte Count Ratio (NLR) as a prognostic utility in patients with COVID-19 for clinical use. Methods In a retrospective study, we collected data from 349 hospitalized patients who diagnosed as the infection of the COVID-19 in Wuhan Pulmonary Hospital. We used ROC curves and Cox regression analysis to explore critical value (optimal cut-off point associated with Youden index) and prognostic role of dynamic changes of D-Dimer and NLR. Results 349 participants were enrolled in this study and the mortality rate of the patients with laboratory diagnosed COVID-19 was 14.9%. The initial and peak value of D-Dimer and NLR in deceased patients were higher statistically compared with survivors (P<0.001). There was a more significant upward trend of D-Dimer and NLR during hospitalization in the deceased patients, initial D-Dimer and NLR were lower than the peak tests (MD) -25.23, 95% CI: -31.81- -18.64, P <0.001; (MD) -43.73, 95% CI:-59.28- -31.17, P <0.001. The test showed a stronger correlation between hospitalization days, PCT and peak D-Dimer than initial D-Dimer. The areas under the ROC curves of peak D-Dimer and peak NLR tests were higher than the initial tests (0.94(95%CI: 0.90-0.98) vs. 0.80 (95% CI: 0.73-0.87); 0.93 (95%CI:0.90-0.96) vs. 0.86 (95%CI:0.82-0.91). The critical value of initial D-Dimer, peak D-Dimer, initial NLR and peak NLR was 0.73 mg/L, 3.78 mg/L,7.13 and 14.31 respectively. 35 (10.03%) patients were intubated. In the intubated patients, initial and peak D-Dimer and NLR were much higher than non-intubated patients (P<0.001). The critical value of initial D-Dimer, peak D-Dimer, initial NLR and peak NLR in prognosticate of intubation was 0.73 mg/L, 12.75 mg/L,7.28 and 27.55. The multivariable Cox regression analysis showed that age (HR 1.04, 95% CI 1.00-1.07, P=0.01), the peak D-Dimer (HR 1.03, 95% CI 1.01-1.04, P<0.001) were prognostic factors for COVID-19 patients’death. Conclusions To dynamically observe the ratio of D-Dimer and NLR was more valuable during the prognosis of COVID-19. The rising trend in D-Dimer and NLR, or the test results higher than the critical values may indicate a risk of death for participants with COVID-19.

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Early Fresh Frozen Plasma Transfusion: Is It Associated With Improved Outcomes of Patients With Sepsis?

Frontiers in Medicine ◽

10.3389/fmed.2021.754859 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaoyi Qin ◽

Wei Zhang ◽

Xiaodan Zhu ◽

Xiang Hu ◽

Wei Zhou

Keyword(s):

Septic Shock ◽

Intensive Care ◽

External Validation ◽

Fresh Frozen Plasma ◽

Plasma Transfusion ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Subset Analysis ◽

Fresh Frozen ◽

Frozen Plasma

Background: So far, no study has investigated the effects of plasma transfusion in the patients with sepsis, especially in the terms of prognosis. Therefore, we aimed to explore the association of early fresh frozen plasma (FFP) transfusion with the outcomes of patients with sepsis.Methods: We performed a cohort study using data extracted from the Medical Information Mart for Intensive Care III database (v1.4). External validation was obtained from the First Affiliated Hospital of Wenzhou Medical University, China. We adopted the Sepsis-3 criteria to extract the patients with sepsis and septic shock. The occurrence of transfusion during the first 3-days of intensive care unit (ICU) stay was regarded as early FFP transfusion. The primary outcome was 28-day mortality. We assessed the association of early FFP transfusion with the patient outcomes using a Cox regression analysis. Furthermore, we performed the sensitivity analysis, subset analysis, and external validation to verify the true strength of the results.Results: After adjusting for the covariates in the three models, respectively, the significantly higher risk of death in the FFP transfusion group at 28-days [e.g., Model 2: hazard ratio (HR) = 1.361, P = 0.018, 95% CI = 1.054–1.756] and 90-days (e.g., Model 2: HR = 1.368, P = 0.005, 95% CI = 1.099–1.704) remained distinct. Contrarily, the mortality increased significantly with the increase of FFP transfusion volume. The outcomes of the patients with sepsis with hypocoagulable state after early FFP transfusion were not significantly improved. Similar results can also be found in the subset analysis of the septic shock cohort. The results of external validation exhibited good consistency.Conclusions: Our study provides a new understanding of the rationale and effectiveness of FFP transfusion for the patients with sepsis. After recognizing the evidence of risk-benefit and cost-benefit, it is important to reduce the inappropriate use of FFP and avoid unnecessary adverse transfusion reactions.

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Early Fresh Frozen Plasma Transfusion: Can It Improve the Outcomes of Patients With Sepsis?

10.21203/rs.3.rs-600661/v1 ◽

2021 ◽

Author(s):

Xiaoyi Qin ◽

Wei Zhang ◽

Xiaodan Zhu ◽

Xiang Hu ◽

Wei Zhou

Keyword(s):

Septic Shock ◽

Intensive Care ◽

External Validation ◽

Fresh Frozen Plasma ◽

Plasma Transfusion ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Subset Analysis ◽

Fresh Frozen ◽

Frozen Plasma

Abstract Background: So far, no study has investigated the effects of plasma transfusion in septic patients, especially in terms of prognosis. Therefore, our purpose is to explore the association of early fresh frozen plasma (FFP) transfusion with the outcomes of septic patients.Methods: We performed a cohort study using data extracted from the Medical Information Mart for Intensive Care Ⅲ database (v1.4). External validation was obtained from the First Affiliated Hospital of Wenzhou Medical University, China. We adopted the Sepsis-3 criteria to extract patients with sepsis and septic shock. The occurrence of infusion during the first 3 days of intensive care unit stay was regarded as early FFP transfusion. The primary outcome was 28-day mortality. We assessed the association of early FFP transfusion with patient outcomes using cox regression analysis. Furthermore, we performed sensitivity analysis, subset analysis and external validation to verify the true strength of the results.Results: After adjusting for the covariates in 3 models respectively, the significantly higher risk of death in the FFP transfusion group at 28 days (e.g. Model 2: HR = 1.361, P = 0.018, 95% CI = 1.054–1.756) and 90 days (e.g. Model 2: HR = 1.368, P = 0.005, 95% CI = 1.099–1.704) remained distinctly. Contrarily, the mortality increased significantly with the increase of FFP transfusion volume. The outcomes of septic patients with low coagulation after early FFP transfusion were not significantly improved. Similar results can also be found in subset analysis of septic shock cohort. The results of external validation exhibited good consistency.Conclusions: Our study provides new understanding of the rationale and effectiveness of FFP transfusion for septic patients. After recognizing the evidences of risk-benefit and cost-benefit, it is important to reduce the inappropriate use of FFP and avoid unnecessary adverse transfusion reactions.

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Correlation Between Neutrophil-lymphocyte Count Ratio and Procalcitonin in Sepsis and Septic Shock

Majalah Kedokteran Bandung ◽

10.15395/mkb.v51n3.1642 ◽

2019 ◽

Vol 51 (3) ◽

pp. 165-171

Author(s):

Jonathan Jonathan ◽

Erwin Pradian ◽

Ardi Zulfariansyah

Keyword(s):

Septic Shock ◽

Lymphocyte Count ◽

Count Ratio ◽

Sepsis And Septic Shock

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