Inflammatory biomarkers as pronostic factors of mortality in critical ILL oncology patients at ICU.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14535-e14535
Author(s):  
Carlos Aliaga Macha ◽  
Thanya Runciman ◽  
Carlos F. Carracedo
Keyword(s):  
Prognostic Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Inflammatory Markers ◽  
Area Under The Curve ◽  
Roc Curves ◽  
P Value ◽  
Predictive Values ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

e14535 Background: Inflammatory markers have been used as prognostic factors in multiple malignancies.In cancer patients, critically ill, the utility of these have limited data.The aim of our study is to determine whether neutrophil lymphocyte ratio (NLR) or lymphocyte platelet ratio(PLR) are prognostic factors for mortality in critically ill patients. Methods: We retrospectively analyzed data of 79 patients with solid tumors admitted to ICU at Sanna-Aliada Clinic between January 2018 to December 2018. Inflammatory markers results were obtained from laboratory tests performed during the first 24h of admission to ICU. Receiving operating characteristic (ROC) curves were constructed and the sensitivity, specificity, predictive values and probability indicators for the NLR and PLR. Results: A total of 79 patients were assessed, 39 women and 40 men. The average age was 60.28 years, median of 61 ( 18 to 91). 51.9% had metastatic disease. The most frequent places were lung 12 (15.2 %) and brain 9 (11,4%) . The main cause for admission to ICU was infectious disease (40.5%). The analysis of normality (Kolmogorov-Smirnov test) indicates that the variables age, hemoglobin, leukocytes, platelets, neutrophils, lymphocytes, have a normal deviation while the other variables: lactate, PCR, neutrophil to lymphocyte ratio (NLR) , Platelet to lymphocyte ratio (PLR) are not distributed normally. Regarding mortality, 44 patients were alive at 30 days (66.7%), and 30 (45.5%) were alive at 90 days. The average stay in the ICU was 8.43 days, with a median of 6, (SD 7.17, 1 to 40 days), 22.8% died in the ICU. The evaluation of PLR and NLR as a mortality marker is significant for the group of patients admitted to the ICU due to a noninfectious pathology, generating an area under the curve (AUC) of 0.706 for NLR (95% CI, 0.535 - 0.876, p-value = 0.035) and 0.767 for PLR (95% CI, 0.615-0.918; p-value = 0.006); the optimal cut point by Youden’s index for NLR was 8.29 and 267.94 for PLR (Sensitivity: 76%, Specificity: 67%). In contrast, the group with infectious pathology, the AUC was 0.47 for NLR (p = 0.78) and 0.42 for PLR (p = 0.44). The relationship of the biomarkers with stay in ICU was also evaluated, finding a statistically significant association with the lactate value (p = 0.024, Kruskal-Wallis) Conclusions: Inflammatory markers are useful as predictive markers of mortality in critically ill patients due to non-infectious causes. The lactate value serves as a predictive factor of stay in the ICU for all the patients. We suggest carrying out prospective studies to confirm the validity of our findings.

Cytomorphometric Neutrophil and Monocyte Markers May Strengthen the Diagnosis of Sepsis

2016 ◽  
Vol 33 (12) ◽  
pp. 656-662
Author(s):  
Joy Mammen ◽  
Jui Choudhuri ◽  
Joshua Paul ◽  
Thomas Isaiah Sudarsan ◽  
T. Josephine ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Donors ◽  
Area Under The Curve ◽  
Standard Test ◽  
Suspected Sepsis ◽  
Predictive Values ◽  
Reactive Protein ◽  
Sensitivity Specificity

Background: The diagnosis of sepsis is challenging in the absence of a gold standard test. Recent studies have explored the role of neutrophil and monocyte volume, conductivity, and scatter (VCS), derived from automated hematology analyzers, in diagnosing sepsis. We assessed the diagnostic accuracy of VCS parameters in critically ill patients with sepsis. Methodology: In this prospective study, VCS parameters, procalcitonin, and C-reactive protein (CRP) were assessed in patients with proven sepsis (cases) and 2 control groups (intensive care unit [ICU] patients without sepsis and healthy blood donors). The diagnostic property of each test was explored by calculating sensitivity, specificity, negative and positive predictive values, and area under the curve (AUC). Results: The study included 65 patients with sepsis, 58 nonseptic ICU controls, and 98 blood donors. Procalcitonin and CRP were not significantly different ( P > .06) between patients with sepsis and nonseptic patients. Mean (95% confidence interval [CI]) neutrophil volume (MNV) was significantly higher ( P < .001) in patients with sepsis (165.5; 95%CI 161.6-169.4) than in nonseptic (157.3; 95%CI 154.6-160.1) patients and donors (148.9; 95%CI 147.9-150). A similar pattern was seen with mean monocyte volume (MMoV). Neutrophil and monocyte conductivity and scatter parameters were variably associated. The AUC was highest for MMoV (0.74) and lowest for CRP (0.62). Among all parameters, MNV and MMoV had the highest specificity of 85% and 80%, respectively. Conclusion: In critically ill patients with suspected sepsis, VCS parameters may help strengthen the diagnostic probability of sepsis. Future studies may explore the role of serial monitoring of VCS to track response to antimicrobial therapy.

scholarly journals Prognostic value of neutrophil/lymphocyte ratio and mean platelet volume/platelet ratio for 1-year mortality in critically ill patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sung Yeon Ham ◽  
Hei Jin Yoon ◽  
Sang Beom Nam ◽  
Byung Hwan Yun ◽  
Darhae Eum ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Mean Platelet Volume ◽  
Independent Predictor ◽  
Platelet Volume ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
The Third ◽  
Survivor Group ◽  
Kaplan Meier

AbstractSeveral studies have reported that the neutrophil to lymphocyte ratio (NLR) and mean platelet volume (MPV) are associated with poor prognosis. This study investigated whether NLR and/or the MPV/platelet ratio could function as predictive markers of mortality in critically ill patients. We retrospectively reviewed 1,154 patients admitted to the intensive care unit (ICU) between January 2017 and December 2017. Patients were divided into 2 groups according to 1-year mortality. We compared the NLR and MPV/platelet ratio on each day of ICU admission. Patients were classified into tertiles based on their NLR and MPV/platelet ratios, and the incidence of 1-year mortality was compared. Kaplan–Meier survival curves were plotted to evaluate their potential as prognostic factors for 1-year mortality. The NLR and MPV/platelet ratio were higher in the non-survivor group than in the survivor group. The incidence of 1-year mortality was the highest in the third tertile for both the NLR and MPV/platelet ratio. The MPV/platelet ratio was an independent predictor for 1-year mortality based on the Kaplan–Meier survival analysis. Our data showed that the MPV/platelet ratio is a predictive factor for 1-year mortality in critically ill patients.

Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes

2014 ◽  
Vol 32 (12) ◽  
pp. 1476-1480 ◽  
Author(s):  
Nazire Belgin Akilli ◽  
Mehmet Yortanlı ◽  
Hüseyin Mutlu ◽  
Yahya Kemal Günaydın ◽  
Ramazan Koylu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Long Term Outcomes ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Short And Long Term ◽  
Prognostic Importance

scholarly journals Optimized Combination of Circulating Biomarkers as Predictors of Prognosis in AECOPD Patients Complicated with Heart Failure

2020 ◽  
Author(s):  
Can Yao ◽  
Lingwei Wang ◽  
Fei Shi ◽  
Rongchang Chen ◽  
Binbin Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Chronic Obstructive ◽  
Circulating Biomarkers ◽  
Operating Characteristics ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Survivor Group ◽  
Significant Difference

Abstract BackgroundSystematic inflammation, nutritional status, and cardiovascular function have been associated with the outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with heart failure (HF). However, the value of their relevant biomarkers in predicting mortality has not been well defined yet. We aimed to investigate the prognostic value of circulating biomarkers including C-reaction protein (CRP) /albumin (ALB), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and N-terminal pro-brain natriuretic peptide (NT-proBNP) for AECOPD patients with HF.Methods A total of 146 cases of AECOPD complicated with HF were enrolled and classified into survivor group (n=94) and non-survivor group (n=52). The baseline characteristics and blood-based biomarkers were collected. The predictors for prognosis were analyzed by multivariate logistic regression, and the ability to predict 28-day mortality was evaluated by receiver operating characteristics curve (ROC) and the area under the curve (AUC).ResultsThe patients in non-survivors had significantly higher levels of CRP, CRP/ALB, NLR, PCT and NT-proBNP, but lower ALB levels compared to the survivors [145.8±110.1 VS. 66.6±70.2mg/L, 5.9±4.9 VS. 2.3±2.6, 22.2 (11.1, 40.1) VS. 12.0 (6.2, 24.8), 2.6 (0.2, 10.3) VS. 0.08 (0.1, 0.5)ng/ml, 17912.5 (9344.0, 34344.5) VS. 9809.0 (4415.9, 16387.2)ng/ml, 26.8±6.4 VS. 31.0±4.6g/L; P < 0.001, <0.001, 0.001, <0.001, <0.001, and < 0.001, respectively]. No significant difference in PLR was found between the two groups (P=0.413). The logistic analysis revealed that CRP/ALB (OR=1.303, 95%CI: 1.145-1.483, P<0.001), NT-proBNP (OR=1.041, 95%CI: 1.010-1.073, P=0.009) and NLR (OR=1.010, 95%CI: 0.999-1.022, P<0.001) are independent risk factors for predicting the 28-day mortality. The AUC of the ROC curves were 0.768, 0.767, 0.757, 0.723, 0.716, and 0.668 for CRP/ALB, PCT, CRP, NT-proBNP, ALB, and NLR, respectively. The combination of CRP/ALB, NLR and NT-proBNP as biomarkers was shown to have better accuracy for predicting prognosis (AUC=0.830, 95%CI: 0.761-0.899, P<0.001), with a higher specificity of 80.8% and specificity of 77.7% as compared with each single biomarkers.ConclusionsHigh levels of NLR, CRP/ALB and NT-proBNP may be clinical usefully predictors for death in AECOPD patients with HF. Combination of NLR with CRP/ALB and NT-proBNP can provide a higher accuracy for predicting 28-day mortality in these patients.

scholarly journals Tocilizumab as a Therapeutic Agent for Critically Ill Patients Infected with SARS-CoV-2

2020 ◽  
Author(s):  
Russell M. Petrak ◽  
Nathan C. Skorodin ◽  
Nicholas W. Van Hise ◽  
Robert M. Fliegelman ◽  
Jonathan Pinsky ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Inflammatory Markers ◽  
Chart Review ◽  
Therapeutic Agent ◽  
P Value ◽  
Cytokine Storm ◽  
Multi Center Study ◽  
Center Study

AbstractBackgroundTocilizumab is an IL-6 receptor antagonist with the ability to suppress the cytokine storm in critically ill patients infected with SARS-CoV-2.MethodsWe evaluated patients treated with tocilizumab for a SARS-CoV-2 infection who were admitted between 3/13/20 and 4/16/20. This was a multi-center study with data collected by chart review both retrospectively and concurrently. Parameters evaluated included age, sex, race, use of mechanical ventilation (MV), usage of steroids and vasopressors, inflammatory markers, and comorbidities. Early dosing was defined as a tocilizumab dose administered prior to or within one (1) day of intubation. Late dosing was defined as a dose administered greater than one (1) day after intubation. In the absence of mechanical ventilation, the timing of the dose was related to the patient’s date of admission only.ResultsWe evaluated 145 patients. The average age was 58.1 years, 64% were male, 68.3% had comorbidities, and 60% received steroid therapy. Disposition of patients was 48.3% discharged and 29.3% expired, of which 43.9% were African American. Mechanical ventilation was required in 55.9%, of which 34.5% expired. Avoidance of MV (p value = 0.002) and increased survival (p value < 0.001) was statistically associated with early dosing.ConclusionsTocilizumab therapy was effective at decreasing mortality and should be instituted early in the management of critically ill COVID-19 patients.SummaryUtilizing tocilizumab early in the treatment course of critically ill patients with COVID-19 resulted in significant decreases in mortality and the avoidance of mechanical ventilation.

MO379EVALUATION OF NEUTROPHIL-LYMPHOCYTE RATIO IN PROGNOSIS OF SEVERE ACUTE RENAL INJURY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Lei Chen ◽  
Limin Wei
Keyword(s):  
Logistic Regression ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Predictive Value ◽  
Binary Logistic Regression ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Prognosis Evaluation

Abstract Background and Aims Recently, more and more attention has been paid to the predictive value of neutrophil to lymphocyte ratio (NLR) in various diseases. As a novel marker for inflammatory response, NLR has been proved to be useful for the diagnosis and prognosis evaluation of inflammatory diseases such as tumor, diabetes, atherosclerosis and other disease. It is well known that inflammatory response plays an important role in the occurrence and development of AKI. Previous studies have shown that NLR has a great value in the diagnosis of AKI, but its value in the prognosis evaluation in AKI patients, especially in critical ill patients with AKI, remains unclear. This study aimed at investigating the predictive value of neutrophil-lymphocyte ratio (NLR) on the risk of 90-day mortality in critically ill patients with acute kidney injury (AKI), so as to provide a simple, feasible, and valuable tool for the prognosis assessment of such patients. Method The data of 802 critically ill patients with AKI admitted to the intensive care unit of the First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2019 were retrospectively analyzed. According to the initial NLR level at admission, they were divided into a low NLR group (NLR≤9) and a high NLR group (NLR&gt;9). Differences in comorbidities, the initial Sequential Organ Failure Assessment (SOFA) score, white blood cell (WBC), neutrophil percentage (Neu%), hemoglobin (Hb), platelet (PLT), lactic acid (Lac), pH, blood glucose (Glu), creatine kinase (CK), and all-cause mortality at 90-day were compared between groups. Binary Logistic regression model was used to analyze the risk factors for 90-day mortality in critically ill patients with AKI, and the receiver operating characteristic (ROC) curve was computed to evaluate the predictive value of NLR for the risk of 90-day mortality in such patients. Results There were no statistically significant differences in age, sex, and Glu between the two groups. The SOFA score, WBC, Hb, Plt, Lac, CK, SC, BUN and NEU％of patients in the high NLR group were higher than those in the low NLR group, while the BMI and pH value was lower in the high NLR group than that in the low NLR group. The 90-day mortality rate was significantly higher in the high NLR group than that in the low NLR group (36.2% vs 16%, P &lt; 0.001). Binary Logistic regression showed that NLR was an independent risk factor for 90-day mortality in critically ill patients with AKI (OR＝2.402, 95% CI:1.633-3.533,ï¼°＜0.001), even after adjusting for age, gender, BMI, comorbidities, SOFA score, and AKI stages. The area under the ROC curve (AUC) of NLR predicting 90-day mortality was 0.613 with a highest prognostic cut-off point of 8. The sensitivity was 65.77%, and the specificity was 54.78%. Conclusion NLR has a predictive value on risk of the 90-day mortality in critically ill patients with AKI. As a simple and easily available clinical indicator, NLR could be applied as a valuable tool in guiding the initial treatment of such patients.

scholarly journals High Neutrophil-lymphocyte Ratio Is a Prognostic Marker for Mortality in Severe Covid-19 and Is Associated With Elevated Age and Kidney Failure

2021 ◽  
Author(s):  
Heitor Santos ◽  
Felipe Delpino ◽  
Octavio Veloso ◽  
Juliana Freire ◽  
Erlaine Gomes ◽  
...  
Keyword(s):  
Critically Ill ◽  
Prognostic Marker ◽  
Kidney Failure ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Crude Model ◽  
Obesity Hypertension

Abstract Neutrophil and lymphocyte ratio (NLR) has emerged as a prognostic marker in intensive care. This study aimed to associate high NLR values with COVID-19-associated diseases and mortality among critically ill patients. A cross-sectional study encompassing 189 critically ill patients with COVID-19 was performed. Crude model and adjusted (1- age; 2- sex; 3- kidney failure, diabetes, obesity, hypertension, sex, and age) modes were used. Participants with NLR ≥10.6 were older than those with NLR <10.6 (p < 0.001). The number of deaths (37 vs. 18, p = 0.001) and patients with kidney failure (30 vs. 20, p = 0.045) were higher for NLR ≥10.6 than NLR <10.6. NLR ≥10.6 was associated with higher number of deaths for the crude model (OR: 3.10 [95%CI:1.60-6.01], p = 0.001), age-adjusted (OR: 2.62 [95%CI:1.32-5.20], p = 0.006) and sex-adjusted (OR: 2.97 [95%CI:1.52-5.78], p = 0.031), as well as in the fully-adjusted model (OR: 2.48 [95%CI:1.21-5.08], p = 0.013), when compared to NLR <10.6. Older adults (≥60y) had an OR of 2.61 (95%CI:1.26-5.39, p = 0.010) for mortality compared to adults (≤59y), and the same value was found for the model adjusted for sex (OR: 2.61 [95%CI:1.26-5.42], p = 0.010). Kidney failure was associated with mortality for the crude model (OR: 2.58 [95%CI:1.30-5.11], p = 0.007), age-adjusted (OR: 2.09 [95%CI:1.02-4.27], p = 0.044), and sex-adjusted (OR: 2.45 [95%CI:1.23-4.89], p = 0.011). In conclusion, high NLR is a prognostic marker for mortality in severe COVID-19 and is associated with advanced age and kidney failure.

Sign in / Sign up

Export Citation Format

Share Document