An Increasing Neutrophil-to-Lymphocyte Ratio Trajectory Predicts Organ Failure in Critically-Ill Male Trauma Patients. An Exploratory Study

Abstract

Background: Although the association of neutrophil proportions with mortality in trauma patients has recently been shown, there is a paucity of research on the association with other outcomes. We sought to investigate the association of neutrophil proportions with organ failure in critically-ill trauma patients. Methods: We reviewed a randomly-selected group of trauma patients admitted to our level-1 trauma intensive care unit between July 2007 and December 2016. Data collected included demographics, injury mechanism and severity (ISS), neutrophil-to-lymphocyte ratio (NLR) at admission and at 24 and 48 hours and organ failure data. NLR patterns during the first 48 hours were divided into two trajectories identified by applying factor and cluster analysis to longitudinal measures. Logistic regression was performed for the association between NLR trajectories and any organ failure; negative binomial regression was used to model the number of organ failures and stage of kidney failure measured by KDIGO classification. Results: 207 patients had NLR data at all three time points. The average age was 44.9 years with mean ISS of 20.6. Patients were 72% male and 23% had penetrating trauma. The 74 patients (36%) with Trajectory 1 had a mean NLR at admission of 3.6, which increased to 14.7 at 48 hours. The 133 (64%) patients in Trajectory 2 had a mean NLR at admission of 8.5 which decreased to 6.6 at 48 hours. Mean NLR was different between the two groups at all three time points (all p < 0.01). There was no significant difference in ISS, age or gender between the two trajectory groups. Models adjusted for age, gender and ISS showed that relative to those with trajectory 2, patients with the trajectory 1 were more likely to have organ failure OR 2.96 (1.42–6.18; p < 0.01), higher number of organ failures IRR 1.50 (1.13–2.00, p < 0.01), and degree of AKI IRR 2.06 (1.04–4.06, p = 0.04). In all cases, the estimated associations were higher among men vs. women, and all were significant among men, but not women. Conclusions: Trauma patients with an increasing NLR trajectory over the first 48 hours had increased risk, number and severity of organ failures. Further research should focus on the mechanisms behind this difference in outcome.

Cutaneous lewisite exposure causes acute lung injury

“…6B and D). The neutrophil–lymphocyte ratio (NLR) has been recently recognized as an independent prognostic indicator of systemic inflammation 18 and organ failure 19 . This ratio was found elevated upon lewisite exposure (Fig.…”

Cohort retrospective study: the neutrophil to lymphocyte ratio as an independent predictor of outcomes at the presentation of the multi-trauma patient

“…Few studies have evaluated the association between NLR and outcomes in multi-trauma patients, demonstrating worse outcomes with increasing NLR. A recent study had found that a trajectory of increasing NLR over the first 48 h of admission is associated with the development of organ failure among male trauma patients [10]. Another study realizes that NLR is strongly associated with early mortality in trauma patients with severe hemorrhage managed with multi-transfusion protocol (MTP) [11].…”

Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities

“…High serum levels of IL-8 and over-expression of its receptor (CXCR2) on the neutrophils in patients with severe trauma have been reported, which correlate with neutrophil hyperactivity and poor prognosis (178,181). Moreover, high levels of NLR (>5.27) over 24 to 48 hours post-trauma are significantly correlated with early MOF (182) and mortality (183). Hence, the level of CD11b and CXCR2, as well as NLR at the time of admission, may be valuable predictors to identify the inflammatory state and risk of mortality in trauma patients.…”