scholarly journals Neutrophil-to-lymphocyte ratio relation to sepsis severity scores and inflammatory biomarkers in patients with community-acquired pneumonia: A case series

2018 ◽  
Vol 6 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Nikolaos-Dimitrios Pantzaris ◽  
Christina Platanaki ◽  
Charalampos Pierrako ◽  
Vasilios Karamouzos ◽  
Dimitrios Velissaris
Keyword(s):  
Community Acquired Pneumonia ◽  
Small Sample ◽  
Neutrophil To Lymphocyte Ratio ◽  
Apache Ii ◽  
Prognostic Scores ◽  
Lymphocyte Ratio ◽  
Saps Ii ◽  
Severity Scores ◽  
Serum Crp ◽  
The Impact

Abstract Background and Objectives Neutrophil to lymphocyte ratio (NLR) as calculated from the white cell differential blood count is considered a promising marker for the prognosis of patients with various diseases, including sepsis. This study was designed to assess the possible use of neutrophil-to-lymphocyte ratio in the prediction of survival outcomes in patients with community acquired pneumonia (CAP). A secondary objective was to compare the prognostic accuracy of NLR with the commonly used severity scores of sepsis SOFA, APACHE II and SAPS II. Methods This was a retrospective study based on data extracted from 26 patients suffering from acute CAP. The study period was from February 01, 2017 until April 30, 2017. All patients with CAP were presented in the Emergency Department (ED) of the University Hospital of Patras, Greece and were treated after admission in the Internal Medicine Department. The neutrophil-to-lymphocyte ratio (NLR) was calculated from the white blood cell count (WBC) values measured from a peripheral venous blood specimen drawn on admission. It was then compared with C-reactive protein (CRP) serum levels and the sepsis calculated prognostic scores APACHE II, SAPS II and SOFA. The impact of the above parameters was evaluated in relation to the final outcome. Results The mean period of hospitalization for the enrolled patients was 9.3 days (SD 5.8 days). Twenty-four patients (92.3%) got finally discharged from the hospital and two (7.7%) died during the hospitalization. Mean NLR and serum CRP values on admission were 10.2 ± 8.8 (min 1.4; max 34.7) and 11.4 ± 11 mg/dL (min 0.4; max 42.6) respectively. Based on the correlation analysis, serum CRP was more strongly positively correlated with NLR (r = 0.543, P = 0.004), than total WBC (r = 0.454, P = 0.02). None of the biomarkers of inflammation measured or computed in the study (CRP, WBC, NLR) showed any correlation with either the days of hospitalization or the sepsis prognostic scores. Conclusions NLR shows a statistical significant correlation to the commonly used inflammatory markers CRP and total WBC in the small sample size of patients with CAP that we assessed. Although NLR is a simple, cheap and rapidly available measurement in the ED, future, larger prospective studies are warranted to confirm its possible value as a prognostic index in sepsis patients with CAP.

scholarly journals Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients

2018 ◽  
Vol 56 (3) ◽  
pp. 153-157 ◽  
Author(s):  
Dimitrios Velissaris ◽  
Nikolaos-Dimitrios Pantzaris ◽  
Panagiotis Bountouris ◽  
Charalampos Gogos
Keyword(s):  
Emergency Department ◽  
Prognostic Index ◽  
Neutrophil To Lymphocyte Ratio ◽  
Apache Ii ◽  
Prognostic Scores ◽  
Sepsis Severity ◽  
Lymphocyte Ratio ◽  
Saps Ii ◽  
Severity Scores ◽  
Tertiary Center

Abstract Introduction. The neutrophil-to-lymphocyte ratio (NLR) as calculated from the white cell differential blood count is a marker that has been used as a prognostic index when assessing patients suffering from several clinical syndromes, including sepsis. The aim of this study was to evaluate the relationship between NLR and the commonly used severity scores of sepsis SOFA, APACHE II and SAPS II in a population of emergency admitted adult patients with sepsis in a tertiary center. Methods. A prospective observational study was conducted in the Emergency Department of the University Hospital of Patras, Greece, based on data extracted from 50 patients consecutively enrolled, suffering from sepsis of multiple origin. The study period was from May 01, 2017 until June 30, 2017. The NLR was calculated from the total white blood cell (WBC) count values measured from a peripheral venous blood specimen drawn on admission. C-reactive protein (CRP) was also measured. The sepsis severity prognostic scores APACHE II, SAPS II and SOFA were calculated for each patient. Results. NLR was positively correlated with the sepsis severity prognostic scores on admission (SOFA, rs = 0.497, p < 0.001; APACHE II, rs = 0.411, p = 0.003; SAPS II, rs = 0.445, p = 0.001). Total WBC was also significantly correlated with the scores (SOFA, rs = 0.342, p = 0.015; APACHE II, rs = 0.384, p = 0.006; SAPS II, rs = 0.287, p = 0.043). Serum CRP did not show any significant correlation either to NLR or to the sepsis severity scores on admission. Conclusions. NLR is an easily calculated, cost-efficient index that could be used as a tool for clinicians when assessing sepsis patients in the Emergency Department. Although NLR measurement is simple, and rapidly available, future and larger prospective studies are warranted to confirm its definite value as a prognostic index in sepsis patients.

scholarly journals Effects of Neutrophil-to-Lymphocyte Ratio Combined With Interleukin-6 in Predicting 28-Day Mortality in Patients With Sepsis

2021 ◽  
Vol 12 ◽  
Author(s):  
Shuangqing Liu ◽  
Xinkun Wang ◽  
Fei She ◽  
Wei Zhang ◽  
Hongsheng Liu ◽  
...  
Keyword(s):  
Regression Model ◽  
Roc Curve ◽  
Odds Ratio ◽  
Cox Regression ◽  
Neutrophil To Lymphocyte Ratio ◽  
Apache Ii ◽  
Cox Regression Model ◽  
Lymphocyte Ratio ◽  
Severity Scores ◽  
Scatter Plots

BackgroundThe current study aimed to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR) combined with interleukin (IL)-6 on admission day and the 28-day mortality of septic patients.Material and MethodsWe conducted an observational retrospective study. Patients with presumed sepsis were included. We observed the correlation of studied biomarkers (NLR, IL-6, PCT, and CRP) and the severity scores (APACHE II and SOFA scores) by plotting scatter plots. The relationships of the studied biomarkers and 28-day mortality were evaluated by using Cox regression model, receiver-operating characteristic (ROC) curve, and reclassification analysis.ResultsA total of 264 patients diagnosed with sepsis were enrolled. It was revealed that IL-6 had the strongest correlation with both APACHE II and SOFA scores, followed by the NLR and PCT, and there was no obvious correlation between CRP and the illness severity. NLR and IL-6 were independent predictors of the 28-day mortality in septic patients in the Cox regression model [NLR, odds ratio 1.281 (95% CI 1.159–1.414), P &lt; 0.001; IL-6, odds ratio 1.017 (95% CI 1.005–1.028), P=0.004]. The area under the ROC curve (AUC) of NLR, IL-6 and NLR plus IL-6 (NLR_IL-6) was 0.776, 0.849, and 0.904, respectively.ConclusionOur study showed that the levels of NLR and IL-6 were significantly higher in the deceased patients with sepsis. NLR and IL-6 appeared to be independent predictors of 28-day mortality in septic patients. Moreover, NLR combined with IL-6 could dramatically enhance the prediction value of 28-day mortality.

scholarly journals Improvement of APACHE II score system for disease severity based on XGBoost algorithm

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Luo ◽  
Zhiyu Wang ◽  
Cong Wang
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
External Validation ◽  
Apache Ii ◽  
Validation Dataset ◽  
Apache Ii Score ◽  
Severity Scores ◽  
The Impact ◽  
Improve Patient

Abstract Background Prognostication is an essential tool for risk adjustment and decision making in the intensive care units (ICUs). In order to improve patient outcomes, we have been trying to develop a more effective model than Acute Physiology and Chronic Health Evaluation (APACHE) II to measure the severity of the patients in ICUs. The aim of the present study was to provide a mortality prediction model for ICUs patients, and to assess its performance relative to prediction based on the APACHE II scoring system. Methods We used the Medical Information Mart for Intensive Care version III (MIMIC-III) database to build our model. After comparing the APACHE II with 6 typical machine learning (ML) methods, the best performing model was screened for external validation on anther independent dataset. Performance measures were calculated using cross-validation to avoid making biased assessments. The primary outcome was hospital mortality. Finally, we used TreeSHAP algorithm to explain the variable relationships in the extreme gradient boosting algorithm (XGBoost) model. Results We picked out 14 variables with 24,777 cases to form our basic data set. When the variables were the same as those contained in the APACHE II, the accuracy of XGBoost (accuracy: 0.858) was higher than that of APACHE II (accuracy: 0.742) and other algorithms. In addition, it exhibited better calibration properties than other methods, the result in the area under the ROC curve (AUC: 0.76). we then expand the variable set by adding five new variables to improve the performance of our model. The accuracy, precision, recall, F1, and AUC of the XGBoost model increased, and were still higher than other models (0.866, 0.853, 0.870, 0.845, and 0.81, respectively). On the external validation dataset, the AUC was 0.79 and calibration properties were good. Conclusions As compared to conventional severity scores APACHE II, our XGBoost proposal offers improved performance for predicting hospital mortality in ICUs patients. Furthermore, the TreeSHAP can help to enhance the understanding of our model by providing detailed insights into the impact of different features on the disease risk. In sum, our model could help clinicians determine prognosis and improve patient outcomes.

scholarly journals Serum S100A8 as an early diagnostic biomarker in patients with community-acquired pneumonia

2020 ◽  
Author(s):  
Ling Zheng ◽  
Jun Fei ◽  
Zheng Xu ◽  
Chun-Mei Feng ◽  
Se-Ruo Li ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Inflammatory Cytokines ◽  
Demographic Data ◽  
A549 Cells ◽  
Community Acquired Pneumonia ◽  
Diagnostic Biomarker ◽  
Cross Sectional ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Severity Scores

Abstract Background and Objectives Limited studies suggested that calprotectin may take part in the pathophysiology of community-acquired pneumonia (CAP). Nevertheless, there is no clinical study to analyze the role of S100A8 in CAP patients. The objective of this study was to analyze the association of serum S100A8 with the severity of CAP based on a cross-sectional study. Methods Entire 200 CAP patients and 100 normal subjects were recruited. Demographic data, clinical information and serum were collected on admission. Serum S100A8 and inflammatory cytokines were detected. Results Serum S100A8 was increased in CAP patients on admission. Serum S100A8 was gradually increased in parallel with the CAP severity scores. Serum S100A8 was positively correlated with CAP severity scores (CURB-65, CRB-65, PSI, CURXO and SMART-COP), blood routine parameters (WBC, neutrophil-lymphocyte ratio and monocyte-lymphocyte ratio) and inflammatory cytokines (TNFα, IL-1β and CRP). Furtherly, univariate and multivariate logistical regression analysis revealed that there was a positive association between serum S100A8 with CRB-65, PSI and CURXO. Moreover, the predictive capacity of serum S100A8 was performed by receiver operating characteristic area under the curve (AUC) analysis. The AUCs of S100A8 for CAP and CAP severity were 0.855 and 0.893, respectively. Mechanistic analysis found that S100A8 knockdown alleviated streptococcus pneumoniae-evoked inflammatory cytokines in A549 cells. Conclusion Serum S100A8 on admission was positively associated with the severity of CAP. S100A8 knockdown alleviates streptococcus pneumoniae- evoked inflammatory cytokines in A549 cells, indicating that S100A8 may exert an important role in the pathophysiology of CAP and be an early serum diagnostic biomarker for CAP.

scholarly journals Systemic Immune-Inflammation Index Is Superior to Neutrophil to Lymphocyte Ratio in Prognostic Assessment of Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Cong Jiang ◽  
Yubo Lu ◽  
Shiyuan Zhang ◽  
Yuanxi Huang
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Regression Models ◽  
Roc Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Breast Cancer Patients ◽  
Lymphocyte Ratio ◽  
Immune Inflammation ◽  
The Impact

Background and Methods. As a parameter integrating neutrophil (N), lymphocyte (L), and platelet (P) levels, altered systemic immune-inflammation index (SII) has been investigated in a number of malignant tumor types. Here, we explore the impact of SII in a cohort of 249 breast cancer patients receiving neoadjuvant chemotherapy (NAC), investigating the prognostic value of SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). All patients had complete follow-up data and pathological confirmation of breast cancer by a core needle biopsy prior to NAC treatment and surgery. All blood samples were obtained within one week prior to NAC. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for patient classification by SII, NLR, and PLR. Associations between clinicopathological variables by SII, NLR, and PLR were determined by a chi-squared test or Fisher’s exact test. Overall survival (OS) analysis was performed using Kaplan-Meier plots, log-rank tests, and Cox proportional hazards regression models. The Z test is used to compare the prognostic ability of SII, NLR, and PLR. Results. SII, NLR, and PLR did not define patient groups with distinct clinicopathological characteristics. SII, NLR, and PLR cut-off values were 547, 2.13, and 88.23, as determined by ROC analysis; the corresponding areas under the curve (AUCs) were 0.625, 0.555, and 0.571, respectively. Cox regression models identified SII as independently associated with OS. Patients with low SII had prolonged OS (65 vs. 41 months, P = 0.017 , HR: 3.24, 95% CI: 1.23-8.55). In the Z test, the difference in AUC between SII and NLR was statistically significant ( Z = 2.721 , 95% CI: 0.0194-0.119, P = 0.0065 ). Conclusion. Our study suggests that the pretreatment SII value is significantly correlated with OS in breast cancer patients undergoing NAC and that the prognostic utility of SII is superior to that of NLR and PLR.

scholarly journals The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care

2021 ◽  
Author(s):  
Ömer Faruk Altaş ◽  
Mehmet Kızılkaya
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Risk ◽  
Demographic Data ◽  
Apache Ii ◽  
Prognostic Scores ◽  
Characteristic Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Point Increase

Objective: In this study, we aimed to reveal the level of predicting mortality of the Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (TLR) calculated in patients hospitalized with the diagnosis of pneumonia in the intensive care unit when compared with other prognostic scores. Method: The hospital records of 112 patients who were admitted to the intensive care unit between January 2015 and January 2018 and met the inclusion criteria were retrospectively reviewed. The patients’ demographic data, the NLR and PLR levels, and the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores were calculated from the patient files. Results: Of the 112 patients examined, 70 were males. The risk analysis showed that the male gender had 2.7 times higher risk of mortality. The NLR, PLR, APACHE II, and SOFA values were found statistically significant in predicting mortality (p<0.001). An evaluation of the risk ratios demonstrated that each one point increase in the NLR increased the mortality risk by 5%, and each one point increase in the SOFA score increased the mortality risk by 13% (p<0.05). In the ROC (receiver operating characteristic) analysis, the NLR assessment proved to be the most powerful, most specific, and sensitive test. The cut-off values were 11.3 for the NLR, 227 for the PLR, 29.8 for the APACHE II scores, and 5.5 for the SOFA scores. Conclusion: We believe that NLR and PLR are strong and independent predictors of mortality that can be easily and cost-effectively tested.

scholarly journals Clinical significance of the preoperative main pancreatic duct dilation and neutrophil-to-lymphocyte ratio in pancreatic neuroendocrine tumors (PNETs) of the head after curative resection

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bo Zhou ◽  
Canyang Zhan ◽  
Jie Xiang ◽  
Yuan Ding ◽  
Sheng Yan
Keyword(s):  
Pancreatic Duct ◽  
Neuroendocrine Tumors ◽  
Main Pancreatic Duct ◽  
Curative Resection ◽  
Who Classification ◽  
Prognostic Significance ◽  
Small Sample ◽  
Neutrophil To Lymphocyte Ratio ◽  
Pancreatic Neuroendocrine Tumors ◽  
Lymphocyte Ratio

Abstract Background The present study aimed to investigate the prognostic significance of preoperative main pancreatic duct dilation and the neutrophil-to-lymphocyte ratio (PD-NLR) in pancreatic neuroendocrine tumors (PNETs) of the head after curative resection. Methods Sixty-four consecutive PNETs of the head that underwent curative resection were included in the study. Preoperative main pancreatic duct dilation (PD) was defined as a pancreatic duct dilation greater than 3 mm before surgery. Patients with both PD and an elevated NLR (> 3.13), with PD or elevated NLR, or neither of these characteristics were allocated a PD-NLR score of 2, 1, or 0, respectively. Univariate, multivariate and Kaplan-Meier analyses were used to calculate overall survival (OS) and disease-free survival (DFS). Results Preoperative PD-NLR score was correlated with tumor size (P = 0.005), T-stage (P = 0.016), lymph node metastasis (P <  0.001), distant metastasis (P = 0.005), type of hormone production (P = 0.006), perineural invasion (P = 0.014), and WHO classification (P <  0.001). Patients with a high PD-NLR score had a significantly poor OS and DFS relative to those with a low PD-NLR score (P <  0.001). In the multivariate analysis, PD-NLR score was an independent predictor of OS and DFS for PNET of the head (both P <  0.05). In the analyses of the various subgroups, preoperative PD-NLR score was also a predictor of OS and DFS. Additionally, the survival predictive capability of PD-NLR score was superior to that of WHO classification. Conclusions Despite the retrospective nature and small sample size of the present study, the results suggest that preoperative PD-NLR score can serve as an independent prognostic marker of early survival in patients with PNETs of the head undergoing curative resection. Further large prospective studies are necessary to validate our findings.

scholarly journals An Evaluation of Serum Procalcitonin and C-Reactive Protein Levels as Diagnostic and Prognostic Biomarkers of Severe Sepsis

2015 ◽  
Vol 1 (4) ◽  
pp. 147-153 ◽  
Author(s):  
Janos Szederjesi ◽  
Emoke Almasy ◽  
Alexandra Lazar ◽  
Adina Huțanu ◽  
Iudita Badea ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
The Body ◽  
Apache Ii ◽  
Prognostic Biomarkers ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Saps Ii ◽  
Severity Scores ◽  
Saps Ii Score

Abstract Background: Recommendations have been made, following the multicenter Surviving Sepsis Campaign study, to standardize the definition of severe sepsis with reference to several parameters such as haemodynamic stability, acid-base balance, bilirubin, creatinine, International Normalized Ratio (INR), urine output and pulmonary functional value of the ratio between arterial oxigen partial pressure and inspiratory oxigen concentration. Procalcitonin (PCT) is considered to be a gold standard biomarker for the inflammatory response, and recent studies have shown that it may help to discover whether a seriously ill person is developing sepsis. C-reactive protein (CRP) is also used as a marker of inflammation in the body, as its blood levels increase if there is any inflammation in the body. The aim of this study was to evaluate serum procalcitonin and C-reactive protein levels as diagnostic and prognostic biomarkers of severe sepsis. Material and method: Sixty patients, diagnosed as being “septic”, were admitted to the intensive care unit (ICU). Based on laboratory results and clinical findings a diagnosis of “severe sepsis“ was made, and correlated with PCT and CRP values. The APACHE II, SAPS II and SOFA severity scores were calculated, analyzed and correlated with PCT and CRP. Results: Fifty two patients (86.67%) presented with criteria for severe sepsis. Multivariate correlation analysis indicated a significant positive association between procalcitonin and all severity scores (APACHEII p<0.0001, SOFA p<0.0001, SAPS II p<0.0001). CRP proved to be significantly correlated only with the SAPS II score (p=0.0145). Mortality rate was high, with 48 patients (80%) dying. There was no significant correlation between the levels of the PCT and CRP biomarkers and severe sepsis (p=0.2059 for PCT, p=0.6059 for CRP). Conclusions: The procalcitonin levels are highly correlated with the severity scores (APACHE II, SAPS II, SOFA) regularly used in ICUs and therefore can be used for determining the severity of the septic process. Quantitive procalcitonin and C-reactive protein analysis was not shown to be useful in diagnosing severe sepsis. However, PCT and CRP can be used to predict the fatal progression of the septic patient.

scholarly journals Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Patients with Sepsis: A Prospective Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Xuan Liu ◽  
Yong Shen ◽  
Hairong Wang ◽  
Qinmin Ge ◽  
Aihua Fei ◽  
...  
Keyword(s):  
Observational Study ◽  
Disease Severity ◽  
Prospective Observational Study ◽  
Unfavorable Outcome ◽  
Neutrophil To Lymphocyte Ratio ◽  
Spearman Correlation ◽  
Clinical Prognosis ◽  
Lymphocyte Ratio ◽  
Severity Scores ◽  
Correlation Tests

Background. The neutrophil-to-lymphocyte ratio (NLR) is an easily accessible biological marker that has been reported to represent disease severity. The aim of this study is to investigate the association between NLR and mortality in patients with sepsis.Methods. A total of 333 consecutive adult patients with sepsis were screened for eligibility in this prospective, observational study cohort. Severity scores and leukocyte counts were prospectively recorded upon entry to the intensive care unit (ICU). Receiver operating characteristic (ROC) curves and binary logistic regression models were used to assess the performance of NLR in predicting unfavorable outcome. Correlations between variables and disease severity were analyzed through Spearman correlation tests.Results. Median NLR levels were significantly higher in patients who died than in survivors. NLR had a modest power for predicting poor outcome as suggested by area under the curve (AUC) of0.695±0.036. Multivariate linear regression indicated that increased NLR levels were related to unfavorable outcome independently of the effect of possible confounders. Spearman correlation tests showed that there was a positive correlation between NLR levels and disease severity.Conclusions. Increased NLR levels were independently associated with unfavorable clinical prognosis in patients with sepsis. Further investigation is required to increase understanding of the pathophysiology of this relationship.

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