Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia?

Abstract

Background Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet count (MPV/PC) ratio are readily available parameters that might have discriminative power regarding outcome. The aim of our study was to assess prognostic value of these biomarkers regarding outcome in critically ill patients with secondary sepsis and/or trauma. Methods A total of 392 critically ill and injured patients, admitted to surgical ICU, were enrolled in a prospective observational study. Leukocyte and platelet counts were recorded upon fulfilling Sepsis-3 criteria and for traumatized Injury Severity Score > 25 points. Patients were divided into four subgroups: peritonitis, pancreatitis, trauma with sepsis, and trauma without sepsis. Results NLR and MPV/PC levels were significantly higher in nonsurvivors (AUC/ROC of 0.681 and 0.592, resp., in the peritonitis subgroup; 0.717 and 0.753, resp., in the pancreatitis subgroup); MLR and PLR did not differ significantly. There was no significant difference of investigated biomarkers between survivors and nonsurvivors in trauma patients with and without sepsis except for PLR in the trauma without sepsis subgroup (significantly higher in nonsurvivors, AUC/ROC of 0.719). Independent predictor of lethal outcome was NLR in the whole cohort and in the peritonitis subgroup as well as MPV in the pancreatitis subgroup. Also, there were statistically significant differences in MPV/PC, MLR, and PLR values regarding nature of bacteremia. In general, the lowest levels had been found in patients with Gram-positive blood cultures. Conclusions NLR and MPV were very good independent predictors of lethal outcome. For the first time, we demonstrate that nature of bacteremia influences MPV/PC, MLR, and PLR. In heterogeneous cohort subgroup, analysis is essential.

The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo‐ovarian abscess

“…From this point forward, recent studies showed that PLR was another indicator of inflammation and can be used for predicting the prognosis of septic patients . Djordjevic et al ., compared patients who had polymicrobial and negative blood cultures in the intensive care unit and found that PLR values were lower in patients with polymicrobial blood culture . In addition, Can et al ., reported that there was a positive association between the early onset of neonatal sepsis and PLR .…”

“…23,24 Djordjevic et al, compared patients who had polymicrobial and negative blood cultures in the intensive care unit and found that PLR values were lower in patients with polymicrobial blood culture. 23 In addition, Can et al, reported that there was a positive association between the early onset of neonatal sepsis and PLR. 24 In our study, there was not a statistically significant difference between groups in terms of PLR.…”

Composite bioscore is superior to routine biomarkers and established scoring systems in predicting mortality in adult critically ill patients with secondary sepsis

“…Apart from presepsin, mean platelet volume and lactate levels were included. We demonstrated, in our previous research, that mean platelet volume was independent predictor of lethal outcome in critically ill and injured patients who developed secondary sepsis (3). Lactate levels are routinely used to assess circulatory function and tissue perfusion.…”

“…It is evident that this life-threatening organ dysfunction, resulting from uncontrolled host response to infection, is responsible for one fifth of all deaths despite all the latest technology and newer antibiotics. Bearing in mind the importance of mortality prediction in critically ill septic patients, investigators, over the years, focused their attention to various potential biomarkers in this regard (2,3). So far, no specific biomarkers for mortality prediction in this patient population have been identified.…”

Mean Platelet Volume-to-Platelet Count Ratio, Mean Platelet Volume-to-Lymphocyte Ratio, and Red Blood Cell Distribution Width-Platelet Count Ratio as Markers of Inflammation in Patients with Ascending Thoracic Aortic Aneurysm

“…In the literature, MPVPCR has been reported to be high in cases such as sepsis [19] , hepatic fibrosis [20] , peritonitis and pancreatitis [21] , and this situation is reported to be associated with mortality. However, in studies performed, it was shown that MPVPCR value is more determinant than MPV value in predicting complications and cardiac mortality due to non-ST segment elevation myocardial infarction disease [22] .…”