Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Rehman, Fazal Ur; Khan, Asadullah; Aziz, Adil; Iqbal, Madiha; Mahmood, Syed Usman Bin; Ali, Nasreen

doi:10.7759/cureus.10851

Cited by 23 publications

(28 citation statements)

References 26 publications

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“…In addition, there was statistically significantly higher proportion of CLD, MAP ≤ 50 mmHg, serum creatinine > 2.2 mg/dl, GCS <13, serum albumin ≤ 2.97 g/dL, serum bilirubin > 1.4 mg/dL, INR > 1.3, serum sodium ≤ 131 mEq/L, NLR > 10, CRP >12, APACHE II score > 19, SOFA score > 3 in non-survivors vs survivors. This came in the same line with Rehman and his colleagues (15) , who have demonstrated that the NLR showed significant associations with all the tested lab parameters of sepsis, such as CRP (p = 0.02), procalcitonin (p=0.01), and SOFA score (p=0.01). Values when analyzed according to culture-positive showed higher values in culturepositive samples but were not statistically significant.…”

Section: Discussionsupporting

confidence: 86%

Neutrophil -To- Lymphocyte Ratio [NLR] as A Promising Prognostic Marker in Critically Ill Septic Patients

Shalaby¹,

Mageed²,

Gouda³

2022

The Egyptian Journal of Hospital Medicine

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Background: NLR is advantageous in regard to simplicity, low cost, and availability compared to many other previously proposed biomarkers, which makes it promising for diagnostic clinicians. Several studies have reported that the NLR is useful in various clinical situations. Objective: To determine whether NLR obtained from complete blood count (CBC) and with simple calculation can be used to predict mortality in patients with sepsis and septic shock in the ICU in comparison with intensive care unit (ICU) severity scores. Patients and methods: This prospective trial was carried out on 84 ICU cases with severe sepsis, who were admitted to Specialized Medical Hospital ICUs from June 2020 to June 2021. Results: There was statistically significantly higher systolic blood pressure (mmHg), mean arterial pressure, rate pressure product *10^3, EF, INR, RBS, PH, HCO3, L *10^3, platelet count, CRP on admission, ABACHEII score, SOFA score on admission, duration of hospital stay (days), and a statistically significantly lower age (years), diastolic blood pressure (mmHg), heart rate, respiratory rate (RR), GCS, serum creatinine (mg/dl), serum albumin, serum bilirubin, Na, K, total leucocytic count *10^3, N *10^3, in group B NLR >10 vs. group A NLR≤ 10. Conclusion:Neutrophil to lymphocyte ratio is a cheap and rapidly available predictor of sepsis and has shown a significant correlation with other relatively expensive and non-rapidly existing markers of inflammation and sepsis with comparable efficacy with ICU severity scores [SOFA and APACHE II].

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Section: Discussionsupporting

confidence: 86%

Neutrophil -To- Lymphocyte Ratio [NLR] as A Promising Prognostic Marker in Critically Ill Septic Patients

Shalaby¹,

Mageed²,

Gouda³

2022

The Egyptian Journal of Hospital Medicine

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“…An elevated NLR likely represents dysregulation of the immune system reflecting an increased innate and attenuated adaptive immune response (8, 50). In addition to playing a role in ICH and stroke (26, 51) an elevated NLR has been linked to outcomes in patients with cancer, myocardial infarction, and sepsis (31,(52)(53)(54)(55)(56). Neutrophils infiltrate the cerebral vasculature within 10 min after SAH, and reduction of neutrophil levels or activity improves vascular integrity and outcomes in animal models (14, 57).…”

Section: Discussionmentioning

confidence: 99%

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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Objective: Systemic inflammation after subarachnoid hemorrhage (SAH) is implicated in delayed cerebral ischemia (DCI) and adverse clinical outcomes. We hypothesize that early changes in peripheral leukocytes will be associated with outcomes after SAH.Methods: SAH patients admitted between January 2009 and December 2016 were enrolled into a prospective observational study and were assessed for Hunt Hess Scale (HHS) at admission, DCI, and modified Ranked Scale (mRS) at discharge. Total white blood cell (WBC) counts and each component of the differential cell count were determined on the day of admission (day 0) to 8 days after bleed (day 8). Global cerebral edema (GCE) was assessed on admission CT, and presence of any infection was determined. Statistical tests included student's t-test, Chi-square test, and multivariate logistic regression (MLR) models.Results: A total of 451 subjects were analyzed. Total WBCs and neutrophils decreased initially reaching a minimum at day 4–5 after SAH. Monocyte count increased gradually after SAH and peaked between day 6–8, while basophils and lymphocytes decreased initially from day 0 to 1 and steadily increased thereafter. Neutrophil to lymphocyte ratio (NLR) reached a peak on day 1 and decreased thereafter. WBCs, neutrophils, monocytes, and NLR were higher in patients with DCI and poor functional outcomes. WBCs, neutrophils, and NLR were higher in subjects who developed infections. In MLR models, neutrophils and monocytes were associated with DCI and worse functional outcomes, while NLR was only associated with worse functional outcomes. Occurrence of infection was associated with poor outcome. Neutrophils and NLR were associated with infection, while monocytes were not. Monocytes were higher in males, and ROC curve analysis revealed improved ability of monocytes to predict DCI and poor functional outcomes in male subjects.Conclusions: Monocytosis was associated with DCI and poor functional outcomes after SAH. The association between neutrophils and NLR and infection may impact outcomes. Early elevation in monocytes had an improved ability to predict DCI and poor functional outcomes in males, which was independent of the occurrence of infection.

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“…Changes in NLR are indicative of the balance between neutrophil and lymphocyte counts. Several authors showed that NLR is an early biomarker of sepsis, regardless of the source of sepsis, and correlates with sepsis severity scores, such as The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and SOFA score [100][101][102][103][104][105]. Noteworthy, NLR increases rapidly following infection.…”

Section: Neutrophil-to-lymphocyte Ratiomentioning

confidence: 99%

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

et al. 2021

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Sepsis represents an important global health burden due to its high mortality and morbidity. The rapid detection of sepsis is crucial in order to prevent adverse outcomes and reduce mortality. However, the diagnosis of sepsis is still challenging and many efforts have been made to identify reliable biomarkers. Unfortunately, many investigated biomarkers have several limitations that do not support their introduction in clinical practice, such as moderate diagnostic and prognostic accuracy, long turn-around time, and high-costs. Complete blood count represents instead a precious test that provides a wealth of information on individual health status. It can guide clinicians to early-identify patients at high risk of developing sepsis and to predict adverse outcomes. It has several advantages, being cheap, easy-to-perform, and available in all wards, from the emergency department to the intensive care unit. Noteworthy, it represents a first-level test and an alteration of its parameters must always be considered within the clinical context, and the eventual suspect of sepsis must be confirmed by more specific investigations. In this review, we describe the usefulness of basic and new complete blood count parameters as diagnostic and prognostic biomarkers of sepsis.

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Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Cited by 23 publications

References 26 publications

Neutrophil -To- Lymphocyte Ratio [NLR] as A Promising Prognostic Marker in Critically Ill Septic Patients

Neutrophil -To- Lymphocyte Ratio [NLR] as A Promising Prognostic Marker in Critically Ill Septic Patients

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

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