scholarly journals Neutrophil to Lymphocyte Ratio (NLR)—A Useful Tool for the Prognosis of Sepsis in the ICU

Biomedicines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 75
Author(s):  
Alice Nicoleta Drăgoescu ◽  
Vlad Pădureanu ◽  
Andreea Doriana Stănculescu ◽  
Luminița Cristina Chiuțu ◽  
Paul Tomescu ◽  
...  
Keyword(s):  
Septic Shock ◽  
Prospective Observational Study ◽  
The Body ◽  
Neutrophil To Lymphocyte Ratio ◽  
Medical Emergency ◽  
Sepsis Severity ◽  
Lymphocyte Ratio ◽  
Extreme Response ◽  
Life Threatening ◽  
Prognosis Marker

Sepsis is a life-threatening medical emergency induced by the body¢s extreme response to an infection. Despite well-defined and constantly updated criteria for diagnosing sepsis, it is still underdiagnosed worldwide. Among various markers studied over time, the neutrophil to lymphocyte ratio (NLR) recently emerged as a good marker to predict sepsis severity. Our study was a single-center prospective observational study performed in our ICU and included 114 patients admitted for sepsis or septic shock. Neutrophil to lymphocyte ratio (NLR) is easy to perform, CBC being one of the standard blood tests routinely performed upon admission for all ICU patients. We found that NLR was increased in all patients with sepsis and significantly raised in those with septic shock. NLR correlates significantly with sepsis severity evaluated by the SOFA score (R = 0.65) and also with extensively studied sepsis prognosis marker presepsin (R = 0.56). Additionally, NLR showed good sensitivity (47%) and specificity (78%) with AUC = 0.631 (p < 0.05). NLR is less expensive and easier to perform compared with other specific markers and may potentially become a good alternate option for evaluation of sepsis severity. Larger studies are needed in the future to demonstrate the prognosis value of NLR.

The association between neutrophil-to-lymphocyte ratio and contrast-induced acute kidney injury in patients with carotid artery stenting

Vascular ◽  
2021 ◽  
pp. 170853812110125
Author(s):  
Altuğ Ösken ◽  
Ahmet Öz ◽  
Muhammed Keskin ◽  
Evliya Akdeniz ◽  
Hasan Şahan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Kidney Injury ◽  
Fold Increase ◽  
Multivariate Regression Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Life Threatening ◽  
Prolonged Hospital

Objectives Contrast-induced acute kidney injury (CI-AKI) is a life-threatening complication that leads to comorbidities and prolonged hospital stay lengths in the setting of peripheral interventions. The presence of some CI-AKI risk factors has already been investigated. In this study, we evaluated the predictors of CI-AKI after carotid artery stenting. Methods A total of 389 patients with 50% to 99% carotid artery stenosis who underwent carotid artery stenting were included in this study. Patients were grouped according to CI-AKI status. Results CI-AKI developed in 26 (6.6%) patients. Age, baseline creatinine level, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were higher and estimated glomerular filtration rate, haemoglobin and lymphocyte count were lower in CI-AKI patients. In the multivariate regression analysis, the neutrophil-to-lymphocyte ratio triggered a 1.39- to 2.63-fold increase in the risk of CI-AKI onset ( p < 0.001). Conclusions The neutrophil-to-lymphocyte ratio may be a significant predictor of CI-AKI in patients with carotid artery stenting and higher neutrophil-to-lymphocyte ratio values may be independently associated with CI-AKI.

scholarly journals Correlation of neutrophil-to-lymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19

Narra J ◽  
2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Rizky Sarengat ◽  
Mohammad S. Islam ◽  
Mohammad S. Ardhi
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
National Institutes Of Health ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Lymphocyte Ratio ◽  
Life Threatening ◽  
The Mean

The coronavirus disease 2019 (COVID-19) pandemic has caused millions of deaths worldwide. Acute ischemic stroke is a life-threatening risk factor for COVID-19 infection. Neutrophil-to-lymphocyte ratio (NLR) is one of the predictors of poor prognosis in acute ischemic stroke. The aim of this study was to assess the correlation between NLR values and the clinical outcome of acute thrombotic stroke patients with COVID-19 that was measured using the National Institutes of Health Stroke Scale (NIHSS). A cross-sectional hospital-based study was conducted in Dr. Soetomo General Hospital Surabaya, Indonesia. Patients with acute thrombotic stroke and COVID-19 admitted between 1 March 2020 and 31 May 2021 were recruited. The NLR values and the NIHSS scores were assessed during the admission and the correlation between NLR and NIHSS scores was calculated. This study included 21 patients with acute thrombotic stroke and COVID-19, consisting of 12 males and 9 females. The mean age was 57.6 years old. The mean NLR values was 8.33±6.7 and the NIHSS scores ranging from 1 to 33. Our data suggested a positive correlation between NLR values and NIHSS scores, r=0.45 with p=0.041. In conclusion, the NLR value is potentially to be used as a predictor of the clinical outcome in acute thrombotic stroke patients with COVID-19. However, further study is warranted to validate this finding.

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.

scholarly journals Prognostic value of rise in neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting the mortality in paediatric intensive care

2019 ◽  
Vol 6 (3) ◽  
pp. 1052
Author(s):  
Siby Mathews ◽  
Aswathy Rajan ◽  
Santosh T. Soans
Keyword(s):  
Intensive Care ◽  
Prognostic Value ◽  
Demographic Data ◽  
Medical Science ◽  
Predictive Biomarkers ◽  
Pediatric Intensive Care ◽  
The Body ◽  
Neutrophil To Lymphocyte Ratio ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio

Background: When the body is stressed in diverse pathological conditions, it responds by mounting an inflammatory response. Predictive biomarkers reflecting the response may serve as guide to management. Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio has been frequently used in adult patients as an indicator for mortality. However, no study has looked into their use within pediatric population. The objective of the study is to assess the prognostic value of rise in NLR and PLR in pediatric intensive care as markers of mortality.Methods: A retrospective study based on 3 year data from HIMS and G-HEALTH data systems of AJ Institute of Medical Science, of all patients admitted to PICU after excluding those in whom all the study parameters were not retrievable, were postoperative patients and/or stay was less than 5 days. NLR and PLR ratios were determined and compared to PELOD 2 using SPSS version 17.0.Results: The demographic data was matched. PELOD 2 (>20) predicted mortality in 72.2% of the patients, while NLR increase predicted in 61.1% and PLR increase in 77.8%. A decreasing trend in NLR and PLR were both closely related to better survival. Among the 3, Rise in PLR had higher sensitivity, specificity, PPV, NPV, and overall accuracy of 72.73% (p <0.001) to predict mortality.Conclusions: The study gives an insight into the fact that simple and inexpensive markers such as rise in NLR and PLR helps in predicting the mortality in the pediatric intensive care which is comparable to PELOD 2 score.

scholarly journals Deep Learning Model for Screening Sepsis Using Electrocardiography

2021 ◽  
Author(s):  
Joon-myoung Kwon ◽  
Ye Rang Lee ◽  
Min-Seung Jung ◽  
Yoon-Ji Lee ◽  
Yong-Yeon Jo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Deep Learning ◽  
Characteristic Curve ◽  
External Validation ◽  
Medical Emergency ◽  
Validation Dataset ◽  
Internal Validation ◽  
Significant Difference ◽  
Life Threatening ◽  
Sepsis And Septic Shock

Abstract Background: Sepsis is a life-threatening organ dysfunction and is a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, it is difficult to screen the occurrence of sepsis. In this study, we propose an artificial intelligence based on deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG).Methods: This retrospective cohort study included 46,017 patients who admitted to two hospitals. 1,548 and 639 patients underwent sepsis and septic shock. The DLM was developed using 73,727 ECGs of 18,142 patients and internal validation was conducted using 7,774 ECGs of 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs of 20,101 patients from another hospital to verify the applicability of the DLM across centers.Results: During the internal and external validation, the area under the receiver operating characteristic curve (AUC) of an DLM using 12-lead ECG for screening sepsis were 0.901 (95% confidence interval 0.882–0.920) and 0.863 (0.846–0.879), respectively. During internal and external validation, AUC of an DLM for detecting septic shock were 0.906 (95% CI = 0.877–0.936) and 0.899 (95% CI = 0.872–0.925), respectively. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs were 0.845–0.882. A sensitivity map showed that the QRS complex and T wave was associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who admitted with infectious disease, The AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793–0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs 0.574, p<0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs 0.725, p=0.018).Conclusions: The DLM demonstrated reasonable performance for screening sepsis using 12-, 6-, and single-lead ECG. The results suggest that sepsis can be screened using not only conventional ECG devices, but also diverse life-type ECG machine employing the DLM, thereby preventing irreversible disease progression and mortality.

scholarly journals High Levels of Circulating IL-8 and Soluble IL-2R Are Associated With Prolonged Illness in Patients With Severe COVID-19

2021 ◽  
Vol 12 ◽  
Author(s):  
Aiping Ma ◽  
Liang Zhang ◽  
Xiaokai Ye ◽  
Jing Chen ◽  
Jie Yu ◽  
...  
Keyword(s):  
Disease Severity ◽  
White Blood Cells ◽  
Serum Levels ◽  
The Body ◽  
Neutrophil To Lymphocyte Ratio ◽  
Immunological Parameters ◽  
Lymphocyte Ratio ◽  
Duration Of Illness ◽  
Immunological Phenotype ◽  
Circulating Levels

ObjectivesThe coordinated immune response of the host is the key of the successful combat of the body against SARS-CoV-2 infection and is decisive for the development and progression of COVID-19. In this study, we aimed to investigate whether the immunological phenotype of patients are associated with duration of illness in patients with severe COVID-19.MethodIn this single-center study, 69 patients with severe or critical COVID-19 were recruited retrospectively. Immunological parameters including counts of white blood cells, neutrophils, lymphocytes, the neutrophil-to-lymphocyte ratio, and levels of circulating cytokines and cytokine receptors were screened for their association with disease severity, survival and duration of illness of COVID-19.ResultsOur data confirmed previous results that neutrophil-to-lymphocyte ratio and circulating levels of IL-6 represent prominent biomarker for the prediction of disease severity and survival of COVID-19. However, this study shows for the first time that duration of illness in patients with severe COVID-19 is positively associated with serum levels of IL-8 (P=0.004) and soluble IL-2Rα (P=0.025).ConclusionThe significant association of duration of illness with circulating levels of IL-8 and soluble IL-2Rα in patients with severe COVID-19 implicates that neutrophils and T cells are involved in the evolution of COVID-19.

Epigenetic biomarkers for human sepsis and septic shock: insights from immunosuppression

Epigenomics ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 617-646 ◽  
Author(s):  
Jesús Beltrán-García ◽  
Rebeca Osca-Verdegal ◽  
Carlos Romá-Mateo ◽  
Nieves Carbonell ◽  
José Ferreres ◽  
...  
Keyword(s):  
Septic Shock ◽  
The Body ◽  
Sepsis Management ◽  
Human Sepsis ◽  
Risk Of Death ◽  
Epigenetic Biomarkers ◽  
Life Threatening ◽  
Sepsis Survivors ◽  
New Biomarkers ◽  
Sepsis And Septic Shock

Sepsis is a life-threatening condition that occurs when the body responds to an infection damaging its own tissues. Sepsis survivors sometimes suffer from immunosuppression increasing the risk of death. To our best knowledge, there is no ‘gold standard’ for defining immunosuppression except for a composite clinical end point. As the immune system is exposed to epigenetic changes during and after sepsis, research that focuses on identifying new biomarkers to detect septic patients with immunoparalysis could offer new epigenetic-based strategies to predict short- and long-term pathological events related to this life-threatening state. This review describes the most relevant epigenetic mechanisms underlying alterations in the innate and adaptive immune responses described in sepsis and septic shock, and their consequences for immunosuppression states, providing several candidates to become epigenetic biomarkers that could improve sepsis management and help predict immunosuppression in postseptic patients.

May thrombopoietin be a useful marker of sepsis severity assessment in patients with SIRS entering the emergency department?

2014 ◽  
Vol 0 (0) ◽  
Author(s):  
Elisabetta Segre ◽  
Luca Pigozzi ◽  
Davide Lison ◽  
Emanuele Pivetta ◽  
Ornella Bosco ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Statistical Significance ◽  
Predictive Biomarker ◽  
Allergic Reactions ◽  
Sepsis Severity ◽  
Early Biomarker

AbstractThrombopoietin (TPO), a growth factor primarily involved in regulating thrombopoiesis, has been recently implicated in the pathogenesis of sepsis. TPO levels are, indeed, greatly increased in patients with sepsis compared to control subjects, and correlate with sepsis severity. The aim of this study was to evaluate TPO as predictive biomarker of sepsis and of sepsis severity in patients entering the emergency department (ED) with systemic inflammatory response syndrome (SIRS).This was a prospective observational study. Ours is a sub-study of the ‘Need-speed trial’, a multi-center observational study involving six Italian centers affiliated to the GREAT Italian Network. TPO was measured by ELISA.We enrolled 13 patients with SIRS (6 with acute pancreatitis, 3 with acute heart failure, 1 with pulmonary embolism, and 3 with allergic reactions), and 40 patients with sepsis, eight of whom had severe sepsis and three septic shock. TPO was significantly higher in patients with sepsis than with SIRS. In addition, TPO was higher in patients with severe sepsis than with sepsis, and in patients with septic shock than with severe sepsis, although these differences did not reach the statistical significance.Our preliminary results suggest that TPO may have the potential to be considered a promising early biomarker for both the diagnosis of sepsis and the assessment of sepsis severity in patients with SIRS entering the ED.

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.

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