The role of neutrophil/lymphocyte ratio in predicting the severity of sepsis in a tertiary care hospital in South India: a retrospective study

Authors

  • Alfy Ann George Department of Pathology, Travancore Medical College and Hospitals, Kollam, Kerala, India
  • Teju P. Thomas Department of Critical Care Medicine, Travancore Medical College and Hospitals, Kollam, Kerala, India
  • Abdul Gaffoor Department of Critical Care Medicine, Travancore Medical College and Hospitals, Kollam, Kerala, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20201490

Keywords:

Neutrophil/lymphocyte ratio, Organ involvement, Sepsis, WBC count

Abstract

Background: Sepsis, a syndrome of dysregulated host response to infection leading to life-threatening organ dysfunction, is having a substantial burden in health system. The outcome in sepsis is often time dependent. None of the clinical manifestations nor the age-old markers like ESR, CRP, etc. have proven diagnostic or prognostic of sepsis. This study aims to assess the role of neutrophil: lymphocyte ratio (NLR) in assessing the severity of sepsis within the initial 24 hrs of admission.

Methods: Authors did a retrospective observational study in 208 sepsis patients admitted in the MDICU. The NLR was calculated and the study population was grouped into those with an NLR of more than or equal to 5 and those with less than 5. The patients were also grouped based on the number of organs impaired due to sepsis. The association between these groups were then assessed.

Results: 46 patients (60.5%) with single organ involvement had NLR <5; 30 patients (39.5%) had NLR >5; 27 patients (42.2%) with two organ involvement had NLR <5 and 37 patients (57.8%) had NLR >5. Among patients with more than two organ involvement, 8 patients (21.6%) had NLR <5 and 29 patients (78.4%) had NLR >5. It was found that there is statistically significant association between increase in number of organs involved and NLR more than 5. The chi square test value was 15.691 with a p value was less than 0.001.

Conclusions: In the current study, we have evaluated the role of NLR in sepsis. NLR calculated on the day of admission is a simple parameter that helps to stratify patients into severe risk category. A significant association was found with higher NLR and the number of organs impairment in sepsis.

References

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.

Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Resp Criti Care Med. 2016 Feb 1;193(3):259-72.

Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Criti Care Med. 2013 May 1;41(5):1167-74.

Rello J, Valenzuela-Sanchez F, Ruiz-Rodriguez M, Moyano S. Sepsis: a review of advances in management. Advan Therapy. 2017 Nov 1;34(11):2393-411.

Dellinger RP, Levy MM, Carlet JM. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Criti Care Med. 2008;36:296-327.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 sccm/esicm/accp/ats/sis international sepsis definitions conference. Inten Care Med. 2003 Apr 1;29(4):530-8.

Faix JD. Biomarkers of sepsis. Criti Rev Clin Lab Sci. 2013 Jan 1;50(1):23-36.

Bogar L, Molnar Z, Kenyeres P, Tarsoly P. Sedimentation characteristics of leucocytes can predict bacteraemia in critical care patients. J Clini Pathol. 2006 May 1;59(5):523-5.

Davis BH, Bigelow NC. Comparison of neutrophil CD64 expression, manual myeloid immaturity counts, and automated hematology analyzer flags as indicators of infection or sepsis. Lab Hematol. 2005;11(2):137-51.

Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratislavske lekarske listy. 2001 Feb;102(1):5-14.

Heffernan DS, Monaghan SF, Thakkar RK, Machan JT, Cioffi WG, Ayala A. Failure to normalize lymphopenia following trauma is associated with increased mortality, independent of the leukocytosis pattern. Criti Care. 2012 Feb 1;16(1):R12.

Gurol G, Ciftci IH, Terizi HA, Atasoy AR, Ozbek A, Koroglu M. Are there standardized cutoff values for neutrophil-lymphocyte ratios in bacteremia or sepsis? J Microbiol. Biotechnol. 2015;25:521-5.

Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection. 2017 Jun 1;45(3):299-307.

Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: a prospective observational study. Media Inflam. 2016;2016.

Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Eemerg Med. 2017 Feb 1;35(2):234-9.

Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine. 2018 Jun;97(26).

Hanberg JS, Freiberg MS, Goetz MB, Rodriguez-Barradas MC, Gibert C, Oursler KA, et al. Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Prognostic Inflammatory Biomarkers in Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV), and HIV/HCV Coinfection. InOpen forum infectious diseases 2019;6(10):347.

Shah N, Parikh V, Patel N, Patel N, Badheka A, Deshmukh A, et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III. Inter J Cardiol. 2014;171:390-7.

Li MX, Liu XM, Zhang XF, Zhang JF, Wang WL, Zhu Y, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Inter J Cancer. 2014;134:2403-13.

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Published

2020-04-27

How to Cite

George, A. A., Thomas, T. P., & Gaffoor, A. (2020). The role of neutrophil/lymphocyte ratio in predicting the severity of sepsis in a tertiary care hospital in South India: a retrospective study. International Journal of Research in Medical Sciences, 8(5), 1624–1628. https://doi.org/10.18203/2320-6012.ijrms20201490

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Original Research Articles