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

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 < 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.

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

Journal of Translational Internal Medicine ◽

10.2478/jtim-2018-0009 ◽

2018 ◽

Vol 6 (1) ◽

pp. 43-46 ◽

Cited By ~ 11

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.

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

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2018-0005 ◽

2018 ◽

Vol 56 (3) ◽

pp. 153-157 ◽

Cited By ~ 2

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.

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Preoperative platelet–lymphocyte ratio predicts recurrence of laryngeal squamous cell carcinoma

Future Oncology ◽

10.2217/fon-2019-0527 ◽

2020 ◽

Vol 16 (6) ◽

pp. 209-217

Author(s):

Huijun Chen ◽

Shenghua Song ◽

Liqing Zhang ◽

Weida Dong ◽

Xi Chen ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Regression Model ◽

Cell Carcinoma ◽

Squamous Cell ◽

Laryngeal Squamous Cell Carcinoma ◽

Cox Regression ◽

Cox Regression Model ◽

Lymphocyte Ratio ◽

Platelet Lymphocyte Ratio ◽

Kaplan Meier

Aim: To evaluate the impact of preoperative platelet–lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR), derived NLR (dNLR) and lymphocyte–monocyte ratio (LMR) on the prognosis of laryngeal squamous cell carcinoma. Materials & methods: Overall survival and recurrence-free survival (RFS) were analyzed using Kaplan–Meier estimates. Multivariable Cox regression model was used to evaluate the independent prognostic significance of variables. Results: High PLR (>103.96), NLR (>1.96) and dNLR (>1.70) predicted lower RFS according to Kaplan–Meier method. In COX regression model, patients with high PLR had poor RFS estimates compared with those with lower PLR (p < 0.001). Conclusion: Preoperative PLR was a more valuable prognostic factor than NLR, dNLR and LMR for the recurrence of laryngeal squamous cell carcinoma.

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Association of administration of IFN-α with mortality among patients hospitalized with coronavirus disease 2019

Future Virology ◽

10.2217/fvl-2020-0404 ◽

2021 ◽

Vol 16 (3) ◽

pp. 201-209

Author(s):

Hanqing Liu ◽

Zhouru Ruan ◽

Ziwei Yin ◽

Dan Wu ◽

Hong Zhu

Keyword(s):

Regression Model ◽

Odds Ratio ◽

Clinical Evidence ◽

Cox Regression ◽

Survival Curve ◽

Cox Regression Model ◽

Kaplan Meier ◽

All Cause Mortality ◽

Single Factor Analysis ◽

Critical Patients

Aim: Recent studies on coronavirus disease 2019 (COVID-19) have not offered sufficient clinical evidence to support whether IFN-α can decrease the mortality of patients with COVID-19. Method: In this retrospective study, 103 of 1555 hospitalized COVID-19 patients were treated with IFN-α, and the others matched through propensity score matching. Cox regression model, logistics analysis and Kaplan–Meier statistics depicted the survival curve. Results & conclusion: Single factor analysis demonstrated that fewer deaths occurred in patients treated with IFN-α compared with patients treated without IFN-α (p = 0.000). Logistics analysis showed that patients treated with IFN-α had an all-cause mortality odds ratio = 0.01 (95% CI: 0.001–0.110; p = 0.000). The Cox regression model was utilized to determine an all-cause mortality with a hazard ratio of 0.102 (95% CI: 0.030–0.351; p = 0.000). IFN-α can alleviate disease severity and decrease all-cause mortality, especially in critical patients. IFN-α could effectively treat patients with COVID-19.

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813. The Reduction of the acquisition rate of carbapenem resistant Acinetobacter baumannii after room privatization in the intensive care unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1002 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S448-S449

Author(s):

Jongtak Jung ◽

Pyoeng Gyun Choe ◽

Chang Kyung Kang ◽

Kyung Ho Song ◽

Wan Beom Park ◽

...

Keyword(s):

Regression Model ◽

Acinetobacter Baumannii ◽

Cox Regression ◽

Univariate Analysis ◽

Intervention Group ◽

Feeding Tube ◽

Control Group ◽

Cox Regression Model ◽

Carbapenem Resistant ◽

Hospital Acquired

Abstract Background Acinetobacter baumannii is one of the major pathogens of hospital-acquired infection recently and hospital outbreaks have been reported worldwide. On September 2017, New intensive care unit(ICU) with only single rooms, remodeling from old ICU with multibed bay rooms, was opened in an acute-care tertiary hospital in Seoul, Korea. We investigated the effect of room privatization in the ICU on the acquisition of carbapenem-resistant Acinetobacter baumannii(CRAB). Methods We retrospectively reviewed medical records of patients who admitted to the medical ICU in a tertiary care university-affiliated 1,800-bed hospital from 1 January 2015 to 1 January 2019. Patients admitted to the medical ICU before the remodeling of the ICU were designated as the control group, and those who admitted to the medical ICU after the remodeling were designated as the intervention group. Then we compared the acquisition rate of CRAB between the control and intervention groups. Patients colonized with CRAB or patients with CRAB identified in screening tests were excluded from the study population. The multivariable Cox regression model was performed using variables with p-values of less than 0.1 in the univariate analysis. Results A total of 1,105 cases admitted to the ICU during the study period were analyzed. CRAB was isolated from 110 cases in the control group(n=687), and 16 cases in the intervention group(n=418). In univariate analysis, room privatization, prior exposure to antibiotics (carbapenem, vancomycin, fluoroquinolone), mechanical ventilation, central venous catheter, tracheostomy, the presence of feeding tube(Levin tube or percutaneous gastrostomy) and the length of ICU stay were significant risk factors for the acquisition of CRAB (p< 0.05). In the multivariable Cox regression model, the presence of feeding tube(Hazard ratio(HR) 4.815, 95% Confidence interval(CI) 1.94-11.96, p=0.001) and room privatization(HR 0.024, 95% CI 0.127-0.396, p=0.000) were independent risk factors. Table 1. Univariate analysis of Carbapenem-resistant Acinetobacter baumannii Table 2. Multivariable Cox regression model of the acquisition of Carbapenem-resistant Acinetobacter baumannii Conclusion In the present study, room privatization of the ICU was correlated with the reduction of CRAB acquisition independently. Remodeling of the ICU to the single room would be an efficient strategy for preventing the spreading of multidrug-resistant organisms and hospital-acquired infection. Disclosures All Authors: No reported disclosures

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Testing the proportional hazards assumption in cox regression and dealing with possible non-proportionality in total joint arthroplasty research: methodological perspectives and review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04379-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ilari Kuitunen ◽

Ville T. Ponkilainen ◽

Mikko M. Uimonen ◽

Antti Eskelinen ◽

Aleksi Reito

Keyword(s):

Survival Analysis ◽

Regression Model ◽

Total Joint Arthroplasty ◽

Full Text ◽

Proportional Hazards ◽

Cox Regression ◽

Joint Arthroplasty ◽

Central Research ◽

Cox Regression Model ◽

Pubmed Database

Abstract Background Survival analysis and effect of covariates on survival time is a central research interest. Cox proportional hazards regression remains as a gold standard in the survival analysis. The Cox model relies on the assumption of proportional hazards (PH) across different covariates. PH assumptions should be assessed and handled if violated. Our aim was to investigate the reporting of the Cox regression model details and testing of the PH assumption in survival analysis in total joint arthroplasty (TJA) studies. Methods We conducted a review in the PubMed database on 28th August 2019. A total of 1154 studies were identified. The abstracts of these studies were screened for words “cox and “hazard*” and if either was found the abstract was read. The abstract had to fulfill the following criteria to be included in the full-text phase: topic was knee or hip TJA surgery; survival analysis was used, and hazard ratio reported. If all the presented criteria were met, the full-text version of the article was then read. The full-text was included if Cox method was used to analyze TJA survival. After accessing the full-texts 318 articles were included in final analysis. Results The PH assumption was mentioned in 114 of the included studies (36%). KM analysis was used in 281 (88%) studies and the KM curves were presented graphically in 243 of these (87%). In 110 (45%) studies, the KM survival curves crossed in at least one of the presented figures. The most common way to test the PH assumption was to inspect the log-minus-log plots (n = 59). The time-axis division method was the most used corrected model (n = 30) in cox analysis. Of the 318 included studies only 63 (20%) met the following criteria: PH assumption mentioned, PH assumption tested, testing method of the PH assumption named, the result of the testing mentioned, and the Cox regression model corrected, if required. Conclusions Reporting and testing of the PH assumption and dealing with non-proportionality in hip and knee TJA studies was limited. More awareness and education regarding the assumptions behind the used statistical models among researchers, reviewers and editors are needed to improve the quality of TJA research. This could be achieved by better collaboration with methodologists and statisticians and introducing more specific reporting guidelines for TJA studies. Neglecting obvious non-proportionality undermines the overall research efforts since causes of non-proportionality, such as possible underlying pathomechanisms, are not considered and discussed.

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FRI0181 ORGAN DAMAGE FREE SURVIVAL IN SOUTHERN CHINESE PATIENTS WITH ACTIVE LUPUS NEPHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2552 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 674.1-674

Author(s):

C. C. Mok ◽

C. S. Sin ◽

K. C. Hau ◽

T. H. Kwan

Keyword(s):

Lupus Nephritis ◽

Regression Model ◽

Cox Regression ◽

Organ Damage ◽

Renal Survival ◽

Cox Regression Model ◽

Free Survival ◽

Renal Response

Background:The goals of treatment of lupus nephritis (LN) are to induce remission, retard the progression of chronic kidney disease, prevent organ complications and ultimately reduce mortality. Previous cohort studies of LN have mainly focused on the risk of mortality and development of end stage renal failure (ESRF) (renal survival). The cumulative frequency of LN patients who survive without organ damage, which correlates better with the balance between treatment efficacy and toxicity, as well as quality of life, has not been well studied.Objectives:To study the organ damage free survival and its predictive factors in patients with active LN.Methods:Consecutive patients who fulfilled ≥4 ACR/SLICC criteria for SLE and with biopsy proven active LN between 2003 and 2018 were retrospectivey analyzed. Those with organ damage before LN onset were excluded. Data on renal parameters and treatment regimens were collected. Complete renal response (CR) was defined as normalization of serum creatinine (SCr), urine P/Cr (uPCR) <0.5 and inactive urinary sediments. Partial renal response (PR) was defined as ≥50% reduction in uPCR and <25% increase in SCr. Organ damage of SLE was assessed by the ACR/SLICC damage index (SDI). The cumulative risk of having any organ damage or mortality since LN was studied by Kaplan-Meier’s analysis. Factors associated with a poor outcome were studied by a forward stepwise Cox regression model, with entry of covariates with p<0.05 and removal with p>0.10.Results:273 LN patients were identified but 64 were excluded (organ damage before LN onset). 211 LN patients were studied (92% women; age at SLE 30.4±13.5 years; SLE duration at LN 1.9±3.1years). 47 (22%) patients had nephrotic syndrome and 60 (29%) were hypertensive. Histological LN classes was: III/IV±V (75.1%), I/II (7.8%) and pure V (17.1%) (histologic activity and chronicity score 7.0±4.2 and 1.8±1.5, respectively). Induction regimens were: prednisolone (33.1±17.5mg/day) in combination with intravenous cyclophosphamide (CYC) (21.4%; 1.0±0.2g per pulse), oral CYC (8.6%; 96.4±37.8mg/day), azathioprine (AZA) (14.3%; 78.6±25.2mg/day), mycophenolate mofetil (MMF) (22.8%; 1.9±0.43g/day) and tacrolimus (TAC) (17.1%; 4.3±1.1mg/day). After a follow-up of 8.6±5.4 years, 94(45%) patient developed organ damage (SDI≥1) and 21(10%) patients died. The commonest organ damage was renal (36.3%) and musculoskeletal (17.9%), and the causes of death were: infection (38.1%), malignancy (19.0%), cardiovascular events (9.5%) and ESRF complications (9.5%). At last visit, 114 (55%) patients survived without any organ damage. The cumulative organ damage free survival at 5, 10 and 15 years after renal biopsy was 73.5%, 59.6% and 48.3%, respectively. The 5, 10 and 15-year renal survival rate were 95.2%, 92.0% and 84.1% respectively. In a Cox regression model, nephritic relapse (HR 3.72[1.78-7.77]), proteinuric relapse (HR 2.30[1.07-4.95]) and older age (HR 1.89[1.05-3.37]) were associated with either organ damage or mortality, whereas CR (HR 0.25[0.12-0.50]) at month 12 were associated with organ damage free survival. Baseline SCr, uPCR and histological LN classes were not significantly associated with a poor outcome. Among patients with class III/IV LN, the long-term organ damage free survival were not significantly different in users of MMF (reference) from CYC (IV/oral) (HR 1.45[0.76- 2.75]) or TAC (HR 1.03[0.26-1.62]) as induction therapy.Conclusion:Organ damage free survival is achieved in 55% of patients with active LN upon 9 years of follow-up. CYC/MMF/TAC based induction regimens did not differ for the long-term outcome of LN. Targeting complete renal response and preventing renal relapses remain important goals of LN treatment.Acknowledgments:NILDisclosure of Interests:None declared

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The effect of censoring on a multivariate cox regression model comparing surgical and medical treatment for aortic disease patients

Controlled Clinical Trials ◽

10.1016/s0197-2456(98)80190-6 ◽

1998 ◽

Vol 19 (3) ◽

pp. S78-S79

Author(s):

Charles Oprian ◽

Kwan Hur ◽

William Henderson ◽

Bharat Thakkar ◽

Frederick Masoudi ◽

...

Keyword(s):

Medical Treatment ◽

Regression Model ◽

Cox Regression ◽

Aortic Disease ◽

Cox Regression Model

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Cox regression survival analysis with compositional covariates: Application to modelling mortality risk from 24-h physical activity patterns

Statistical Methods in Medical Research ◽

10.1177/0962280219864125 ◽

2019 ◽

Vol 29 (5) ◽

pp. 1447-1465 ◽

Cited By ~ 11

Author(s):

DE McGregor ◽

J Palarea-Albaladejo ◽

PM Dall ◽

K Hron ◽

SFM Chastin

Keyword(s):

Public Health ◽

Physical Activity ◽

Survival Analysis ◽

Regression Model ◽

Cox Regression ◽

Public Health Problem ◽

Sitting Time ◽

Cox Regression Model ◽

Log Ratio ◽

Activity Behaviour

Survival analysis is commonly conducted in medical and public health research to assess the association of an exposure or intervention with a hard end outcome such as mortality. The Cox (proportional hazards) regression model is probably the most popular statistical tool used in this context. However, when the exposure includes compositional covariables (that is, variables representing a relative makeup such as a nutritional or physical activity behaviour composition), some basic assumptions of the Cox regression model and associated significance tests are violated. Compositional variables involve an intrinsic interplay between one another which precludes results and conclusions based on considering them in isolation as is ordinarily done. In this work, we introduce a formulation of the Cox regression model in terms of log-ratio coordinates which suitably deals with the constraints of compositional covariates, facilitates the use of common statistical inference methods, and allows for scientifically meaningful interpretations. We illustrate its practical application to a public health problem: the estimation of the mortality hazard associated with the composition of daily activity behaviour (physical activity, sitting time and sleep) using data from the U.S. National Health and Nutrition Examination Survey (NHANES).

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Analysis models for variables associated with breastfeeding duration

Revista Paulista de Pediatria ◽

10.1590/s0103-05822013000300006 ◽

2013 ◽

Vol 31 (3) ◽

pp. 306-314 ◽

Cited By ~ 3

Author(s):

Edson Theodoro dos S. Neto ◽

Eliana Zandonade ◽

Adauto Oliveira Emmerich

Keyword(s):

Logistic Regression ◽

Protective Factors ◽

Regression Model ◽

Odds Ratio ◽

Regression Models ◽

Adjusted Odds Ratio ◽

Cox Regression ◽

Bottle Feeding ◽

Breastfeeding Duration ◽

Factors Associated

OBJECTIVE To analyze the factors associated with breastfeeding duration by two statistical models. METHODS A population-based cohort study was conducted with 86 mothers and newborns from two areas primary covered by the National Health System, with high rates of infant mortality in Vitória, Espírito Santo, Brazil. During 30 months, 67 (78%) children and mothers were visited seven times at home by trained interviewers, who filled out survey forms. Data on food and sucking habits, socioeconomic and maternal characteristics were collected. Variables were analyzed by Cox regression models, considering duration of breastfeeding as the dependent variable, and logistic regression (dependent variables, was the presence of a breastfeeding child in different post-natal ages). RESULTS In the logistic regression model, the pacifier sucking (adjusted Odds Ratio: 3.4; 95%CI 1.2-9.55) and bottle feeding (adjusted Odds Ratio: 4.4; 95%CI 1.6-12.1) increased the chance of weaning a child before one year of age. Variables associated to breastfeeding duration in the Cox regression model were: pacifier sucking (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.3) and bottle feeding (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.5). However, protective factors (maternal age and family income) differed between both models. CONCLUSIONS Risk and protective factors associated with cessation of breastfeeding may be analyzed by different models of statistical regression. Cox Regression Models are adequate to analyze such factors in longitudinal studies.

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