Prognostic value of neutrophils to lymphocytes and platelets ratio for 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study

Abstract

Background Acute respiratory distress syndrome (ARDS) is a rapidly progressive and fatal respiratory failure disease that often occurs in critically ill patients. Since ARDS is associated with immune dysregulation and coagulation abnormalities, it is necessary to identify an appropriate predictor that can accurately predict ARDS mortality based on its pathophysiology. Therefore, this study aimed to evaluate the clinical value of neutrophils to lymphocytes and platelets ratio (N/LPR) in predicting 28-day mortality in ARDS patients. Methods From July 2018 to October 2021, the medical records of ARDS patients were retrospective reviewed. Neutrophil count, lymphocyte count, and platelet count were collected, and the neutrophil-to-lymphocyte ratio (NLR) and N/LPR were calculated. Multivariate logistic regression analyses were performed to identify independent predictors of 28-day mortality in ARDS. Receiver operating characteristic (ROC) curve with the area under curve (AUC) was used to evaluate optimal cut-off values for 28-day mortality in ARDS. Kaplan–Meier analysis was used to estimate the 28-day survival probabilities stratified by optimal cut-off values of N/LPR and NLR. Results A total of 136 ARDS patients were included in this study and were further divided into survivors (n = 69) and non-survivors (n = 67) groups according to their survival status on day 28. There were no significant differences between the two groups in age, sex, history of smoking and drinking, comorbidities, and reasons of admission (P > 0.05). Non-survivors had significantly higher neutrophil counts, NLR and N/LPR and had significantly lower platelet counts than survivors (P < 0.05). Multivariate regression analysis revealed that N/LPR, NLR and platelet counts were independent predictors for 28-day mortality in ARDS (P < 0.05). The ROC analyses showed that N/LPR with optimal cut-off value of 10.57 (sensitivity: 74.6%; specificity: 72.5%) is a more reliable predictor for 28-day mortality in ARDS than NLR and platelet count (AUC: 0.785 vs. 0.679 vs. 0.326). Further subgroup analysis confirmed that ARDS patients with N/LPR < 10.57 had significantly lower 28-day mortality than patients with N/LPR ≥ 10.57 (P < 0.001). Kaplan–Meier analysis also confirmed that ARDS patients with N/LPR < 10.57 had significantly longer survival. Conclusion N/LPR is an independent risk factor associated with 28-day mortality in ARDS patients and shows better performance in predicting mortality rate than NLR.

WITHDRAWN: Predictive value of neutrophil-to-lymphocyte ratio in mortality of critically ill patients with atrial fibrillation: a retrospective analysis of the Medical Information Mart for Intensive Care IV Database

“…NLR is an indicator re ecting the in ammatory state in vivo, which is easy to obtain clinically. A large number of studies have shown that NLR is an signi cant prognostic marker for critical diseases such as heart failure, myocardial infarction, ARDS and so on [16][17][18][19]. Moreover, several studies have also found that the increase of NLR before and after catheter ablation was related to the increase of postoperative atrial brillation recurrence [20,21].…”

Evaluation of the Effectiveness of Systemic Inflammatory Indices in the Diagnosis of Respiratory Distress Syndrome in Preterm with Gestational Age of ≤32 Weeks

“…[6][7][8][9] In acute respiratory distress syndrome (ARDS), which progresses with severe respiratory failure in adults, NLR, MLR, and PLR both increase with the severity of the disease and reach higher values in patients who died. [24][25][26][27][28] In the neonatal area, high NLR, MLR and PLR levels have been found to be useful diagnostic tools for hypoxic ischemic encephalopathy, PDA, EOS, ROP, IVH, and NEC. [10][11][12][13][14][15] However, the role of systemic inflammatory indeces in the diagnosis of RDS in premature infants is not clearly known.…”

“…26 In ARDS, platelets interact with neutrophils, causing more neutrophil recruitment, endothelial and immune cell activation, and formation of platelet–neutrophil complexes. 25 The increase in SII as a result of platelet activation, apoptosis in lymphocytes, and increase in neutrophils may reflect the inflammation status more comprehensively by reflecting the balance between platelet, lymphocyte count, and neutrophil count. 26 Thus, it can be used as a prognostic biomarker in patients with ARDS.…”

The expression of peripheral blood inflammatory factors in patients with acute ischemic stroke and its correlation with patients’ prognosis

“…Inflammation may induce secondary brain injury by aggravating blood-brain barrier(BBB) injury, microvascular failure, brain edema, oxidative stress and directly induce neuronal cell death (7). Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are frequently adopted indicators of systemic inflammation and infection (8). It is worth noting that some studies suggest that NLR and PLR probably have better predictive abilities than traditional inflammatory factors (9).…”