Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit

Abstract

IntroductionAbsolute lymphocytopenia has been reported as a predictor of bacteremia in medical emergencies. Likewise, the neutrophil-lymphocyte count ratio (NLCR) has been shown a simple promising method to evaluate systemic inflammation in critically ill patients.MethodsWe retrospectively evaluated the ability of conventional infection markers, lymphocyte count and NLCR to predict bacteremia in adult patients admitted to the Emergency Department with suspected community-acquired bacteremia. The C-reactive protein (CRP) level, white blood cell (WBC) count, neutrophil count, lymphocyte count and NLCR were compared between patients with positive blood cultures (n = 92) and age-matched and gender-matched patients with negative blood cultures (n = 92) obtained upon Emergency Department admission.ResultsSignificant differences between patients with positive and negative blood cultures were detected with respect to the CRP level (mean ± standard deviation 176 ± 138 mg/l vs. 116 ± 103 mg/l; P = 0.042), lymphocyte count (0.8 ± 0.5 × 109/l vs. 1.2 ± 0.7 × 109/l; P < 0.0001) and NLCR (20.9 ± 13.3 vs. 13.2 ± 14.1; P < 0.0001) but not regarding WBC count and neutrophil count. Sensitivity, specificity, positive and negative predictive values were highest for the NLCR (77.2%, 63.0%, 67.6% and 73.4%, respectively). The area under the receiver operating characteristic curve was highest for the lymphocyte count (0.73; confidence interval: 0.66 to 0.80) and the NLCR (0.73; 0.66 to 0.81).ConclusionsIn an emergency care setting, both lymphocytopenia and NLCR are better predictors of bacteremia than routine parameters like CRP level, WBC count and neutrophil count. Attention to these markers is easy to integrate in daily practice and without extra costs.

Diagnostic utility of the neutrophil-to-lymphocyte ratio in patients with acute mesenteric ischemia: A retrospective cohort study

“…Associations are evident between monocyte and lymphocyte counts, as well as between these counts and infection. [7,20] During inflammation, neutrophil counts increase as lymphocyte counts decrease, controlled by neurohormonal mechanisms. Therefore, NLR accurately reflects underlying inflammatory processes.…”

“…[2,6] Recent studies have focused on such materials because early and accurate detection of inflammation is essential in order to optimize treatment and prognosis of those with medical emergencies. [7] Several biomarkers, such as C-reactive protein (CRP), procalcitonin, and mean platelet volume (MPV) have been used as indicators of inflammation. Neutrophilia develops during inflammation, triggered by release of arachidonic acid metabolites and platelet activation.…”

The Change of Neutrophil Lymphocyte Ratio in Acute Appendicitis

“…This marker is cheap, readily accessible and can be calculated quite easily. Recently, neutrophil/lymphocyte ratio (NLR) has been shown to reflect inflammatory burden in some acute inflammatory diseases like to AA [8][9][10][11].…”

The investigation of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in children with pathological cervical lymphadenopathy

“…Parameters such as procalcitonin, pro-adrenomedullin, serum amyloid A, fibrinogen and CD-14 binding protein, which are used following some infections, are extremely expensive tests. [4,5] Recently, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) rates calculated according to hemogram data in patients with a white blood cell count within the normal range can be used to evaluate systemic inflammation. [6,7] In this study, we aimed to reveal whether if NLR and PLR rates are useful or not in children followed-up due to pathological cervical LAP of unknown etiology who have a normal hematologic examination.…”