Are There Standardized Cutoff Values for Neutrophil-Lymphocyte Ratios in Bacteremia or Sepsis?

Abstract

Bacteremia and sepsis are common causes of morbidity and mortality worldwide, with incorrect or delayed diagnoses being associated with increased mortality. New tests or markers that allow a more rapid and less costly detection of bacteremia and sepsis have been investigated. The aim of this study was to clarify the cutoff value of the neutrophillymphocyte ratio (NLR) according to procalcitonin (PCT) level in the decision-making processes for bacteremia and sepsis. In addition, other white blood cell subgroup parameters, which are assessed in all hospitals, for bacteremia and sepsis were explored. This retrospective study included 1,468 patients with suspected bacteremia and sepsis. Patients were grouped according to the following PCT criteria: levels <0.05 ng/ml (healthy group), 0.05-0.5 ng/ml (local infection group), 0.5-2 ng/ml (systemic infection group), 2-10 ng/ml (sepsis group), and >10 ng/ml (sepsis shock group). One important finding of this study, which will serve as a baseline to measure future progress, is the presence of many gaps in the information on pathogens that constitute a major health risk. In addition, clinical decisions are generally not coordinated, compromising the ability to assess and monitor a situation. This report represents the first study to determine the limits of the use of NLR in the diagnosis of infection or sepsis using a cutoff value of <5 when sufficient exclusion criteria are used.

Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever

“…In a study of 1468 patients with suspected bacteremia and septicemia, using procalcitonin (PCT) as a reference, Gürol et al [33] found NLR to have higher sensitivity than CRP and WBC. They suggested the following intervals for local infection [5–10), systemic infection [10–13), septicemia [13–15), and for septic shock at least 15, respectively.…”

Evaluation of eosinophil count and neutrophil-lymphocyte count ratio versus C-reactive protein levels in patients with sepsis

“…In the present study of 50 patients with diagnosis of sepsis and 21 patients with no sepsis NLR ≥5 was used for the diagnosis of patients with sepsis in accordance with the study of Gurol et al, who reported that an NLR value ≥5 may be a more convenient marker than CRP, due to its improved ability to detect bacterial infections at lower cost. 21 The value of NLCR increased from 8.36 ± 1.04 to 8.72 ± 1.01 in sepsis group (p-value 0.592), from 11.32 ± 1.55 to 15.39 ± 5.16 (p-value of 0.155) in severe sepsis group and from 14.70 ± 5.81 to 15.20 ± 6.32 (p-value 0.863) in septic shock group. Also in the patients who survived value of NLCR on day 3 decreased with decreasing severity of sepsis after the initiation of therapy.…”

Neutrophil-to-Lymphocyte Ratio and Non-arteritic Anterior Ischemic Optic Neuropathy

“…As the author(s) commented, the presence of any infection in the period of laboratory testing aside from systemic diseases should be evaluated (4). As stated in the discussion of our article, one drawback of our study was that it was performed retrospectively so we could not evaluate the existence of other systemic diseases; therefore, we concluded that prospective studies were needed.…”