Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department

Lowsby, Richard; Gomes, Clint; Jarman, Ian H.; Lisboa, Paulo J. G.; Née, Patrick; Vardhan, Madhur; Eckersley, Tom; Saleh, Roshan; Mills, Hannah

doi:10.1136/emermed-2014-204071

Cited by 110 publications

(105 citation statements)

References 25 publications

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“…25 Recently, some studies have shown that NLR can be an indicating marker of infection and its severity. 26,27 However, in our study, after adjusting for several risk factors including wound infection, blood glucose levels, and cardiovascular risk factors, NLR could predict complete healing with OR of 3.45 ( P = .01). This result emphasizes the value of NLR in assessing inflammatory mechanisms other than infection in predicting outcome in diabetic foot ulcers.…”

Section: Discussionmentioning

confidence: 50%

Predictive value of neutrophil-to-lymphocyte ratio in diabetic wound healing

Vatankhah

Jahangiri

Landry

et al. 2017

Journal of Vascular Surgery

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Objective The neutrophil-to-lymphocyte ratio (NLR) has been used as a surrogate marker of systemic inflammation. We sought to investigate the association between NLR and wound healing in diabetic wounds. Methods The outcomes of 120 diabetic foot ulcers in 101 patients referred from August 2011 to December 2014 were examined retrospectively. Demographic, patient-specific, and wound-specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing, minor amputation, major amputation, and chronic ulcer. Results The subjects’ mean age was 59.4 ± 13.0 years, and 67 (66%) were male. Final outcome was complete healing in 24 ulcers (20%), minor amputation in 58 (48%) and major amputation in 16 (13%), and 22 chronic ulcers (18%) at the last follow-up (median follow-up time, 6.8 months). In multivariate analysis, higher NLR (odds ratio, 13.61; P = .01) was associated with higher odds of nonhealing. Conclusions NLR can predict odds of complete healing in diabetic foot ulcers independent of wound infection and other factors.

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Section: Discussionmentioning

confidence: 50%

Predictive value of neutrophil-to-lymphocyte ratio in diabetic wound healing

Vatankhah

Jahangiri

Landry

et al. 2017

Journal of Vascular Surgery

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“…Several studies have shown increased NLR in infections [1–5, 25, 26], including meningitis [27]. The MLR has also been applied to this purpose [17–21].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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PurposeTo study the role of the neutrophil:lymphocyte ratio (NLR) and monocyte:lymphocyte ratio (MLR) in discriminating between different patient groups hospitalized for fever due to infection and those without infection.MethodsFor 299 patients admitted to hospital for fever with unknown cause, a number of characteristics including NLR and MLR were recorded. These characteristics were used in a multiple multinomial regression analysis to estimate the probability of a final diagnostic group of bacterial, viral, clinically confirmed, or no infection.ResultsBoth NLR and MLR significantly predicted final diagnostic group. Being highly correlated, however, both variables could not be retained in the same model. Both variables also interacted significantly with duration of fever. Generally, higher values of NLR and MLR indicated larger probabilities for bacterial infection and low probabilities for viral infection. Patients with septicemia had significantly higher NLR compared to patients with other bacterial infections with fever for less than one week. White blood cell counts, neutrophil counts, and C-reactive proteins did not differ significantly between septicemia and the other bacterial infection groups.ConclusionsNLR is a more useful diagnostic tool to identify patients with septicemia than other more commonly used diagnostic blood tests. NLR and MLR may be useful in the diagnosis of bacterial infection among patients hospitalized for fever.

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“…NLR is thought to be an early marker of bacteremia given its positive association with CRP [53], and NLR has also been associated with placental inflammation when NLR ≥ 6.48 and CRP ≥ 71 nmol/L [54]. Activation of platelets occurs in response to inflammatory stimuli [55], and activated platelets are enlarged resulting in higher plateletcrit [56].…”

Section: Discussionmentioning

confidence: 99%

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

et al. 2017

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BackgroundThe usefulness of C-reactive protein (CRP) as a non-specific marker of inflammation during pregnancy and lactation is unclear in impoverished populations where co-existing infections and vitamin deficiencies are common.MethodsThis cross-sectional study in Panama recruited 120 pregnant and 99 lactating Ngäbe-Buglé women from 14 communities in rural Panama. Obstetric history, indoor wood smoke exposure, fieldwork, BMI, vitamins A, B12, D, and folic acid, and inflammation markers (CRP, neutrophil/lymphocyte ratio (NLR), plateletcrit and cytokines) were measured. Multiple regressions explored both associations of CRP with other inflammatory markers and associations of CRP and elevated CRP based on trimester-specific cut-offs with maternal factors, infections and vitamin deficiencies.ResultsCRP was higher in pregnancy (51.4 ± 4.7 nmol/L) than lactation (27.8 ± 3.5 nmol/L) and was elevated above trimester specific cut-offs in 21% of pregnant and 30% of lactating women. Vitamin deficiencies were common (vitamin A 29.6%; vitamin D 68.5%; vitamin B12 68%; folic acid 25.5%) and over 50% of women had two or more concurrent deficiencies as well as multiple infections. Multiple regression models highlighted differences in variables associated with CRP between pregnancy and lactation. In pregnancy, CRP was positively associated with greater indoor wood smoke exposure, caries and hookworm and negatively associated with Ascaris and vaginal Lactobacillus and Bacteroides/Gardnerella scores. Consistent with this, greater wood smoke exposure, caries as well as higher diplococcal infection score increased the odds of trimester-elevated CRP concentrations whereas longer gestational age lowered the likelihood of a trimester-elevated CRP. During lactation, folic acid deficiency was associated with higher CRP whereas parity, number of eosinophils and Mobiluncus score were associated with lower CRP. Also, a higher BMI and Trichomonas vaginalis score increased the likelihood of an elevated CRP whereas higher parity and number of eosinophils were associated with lower likelihood of an elevated CRP.ConclusionsInfections both raise and lower CRP concentrations in pregnant and lactating mothers. Only folic acid deficiency during lactation was associated with higher CRP concentrations. Caution is required when interpreting CRP concentrations in pregnant and lactating women who have co-existing nutrient deficiencies and multiple infections.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0307-1) contains supplementary material, which is available to authorized users.

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Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department

Abstract: Objectives

Cited by 110 publications

References 25 publications

Predictive value of neutrophil-to-lymphocyte ratio in diabetic wound healing

Predictive value of neutrophil-to-lymphocyte ratio in diabetic wound healing

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

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

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