Which hemogram-derived indices might be useful in predicting the clinical outcomes of sepsis patients in the intensive care unit?

Abstract

The aim of our study is to investigate the prognostic value of Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) in determining mortality in patients hospitalized for intensive care unit (ICU) sepsis. Materials and Methods: This study retrospectively evaluates all patients hospitalized with sepsis in our ICU between February 2017 and April 2018. In addition to the demographic and clinical characteristics of the patients, complete blood count parameters were also recorded. Demographic and clinical characteristics, mainly NLR, MLR and PLR results, and other laboratory results of patients with sepsis were compared between the ones with and without mortality. Results: Four hundred and eleven patients were included in the study. 55.7% (229/411) of patients with sepsis died and 44.3% (182/411) were discharged alive. NLR, MLR and PLR were higher in the group with mortality compared to the survivor group. The cut-off value for predicting mortality in patients with sepsis was 9.2 for NLR, ≥0.8 for MLR, and ≥187.3 for PLR. The area under the curve (AUC) value for NLR was 0.825, the AUC value for MLR 0.835 and the AUC value for PLR was 0.720. Conclusion: High NLR, MLR and PLR values are associated with mortality in sepsis patients hospitalized in ICU, and the most significant parameter for mortality indicator among the three rates was found to be MLR with the highest AUC value. Amaç: Çalışmamızın amacı, yoğun bakım ünitesinde (YBÜ) sepsis nedeniyle yatan hastalarda nötrofil lenfosit oranı (NLO), monosit lenfosit oranı (MLO) ve trombosit lenfosit oranı (TLO mortaliteyi belirlemedeki prognostik değerini araştırmaktır. Gereç ve Yöntem: Çalışmamızda, Şubat 2017 -Nisan 2018 tarihleri arasında YBÜ'de yatan tüm sepsisli hastalar retrospektif olarak değerlendirilmiştir. Hastaların demografik ve klinik özelliklerine ek olarak tam kan sayımı parametreleri kayıt edildi. Mortalite olan ve olmayan sepsisli hastaların başlıca NLO, MLO ve TLO sonuçları olmak üzere demografik ve klinik özellikleri ile diğer laboratuvar sonuçları karşılaştırıldı. Bulgular: Çalışmaya 411 hasta dahil edildi. Sepsisli hastaların %55,7'si (229/411) öldü ve %44,3 hasta (182/411) sağ taburcu edildi. Mortalite olan grupta yaşayan gruba göre NLO, MLO ve TLO daha yüksek bulundu. Sepsisli hastalarda mortalite tahmini için eşik NLO için ≥9,2, MLO için ≥0,8, TLO için ≥187,3 olarak bulundu. Nötrofil lenfosit oranı için eğri altında kalan alana (AUC) değeri 0,825, MLO için AUC değeri 0,835 ve TLO için AUC değeri 0,720 olarak bulundu. Sonuç: Yoğun bakım ünitesinde yatan sepsis hastalarında yüksek NLO, MLO ve TLO değerleri mortalite ile ilişkili olup, üç oran arasından mortalite göstergesi için en anlamlı parametre AUC değeri en yüksek olan MLO olarak bulundu.

Prognostic Value of Platelet to Lymphocyte Ratio in Sepsis: A Systematic Review and Meta-analysis

“…Among the 16 included studies, nine studies had prospective designs. Studies were conducted in China ( n = 4) [ 12 , 22 – 24 ], Indonesia ( n = 3) [ 16 , 19 , 20 ], Turkey ( n = 3) [ 10 , 11 , 18 ], Iran ( n = 1) [ 14 ], Serbia ( n = 1) [ 13 ], Saudi Arabia ( n = 1) [ 9 ], Poland ( n = 1) [ 17 ], Korea ( n = 1) [ 15 ], and India ( n = 1) [ 21 ]. Seven studies reported one-month mortality [ 9 , 10 , 12 , 15 , 19 , 21 , 24 ], three studies reported in-hospital mortality [ 13 , 14 , 22 ], and one study investigated ICU mortality [ 17 ].…”

“…Seven studies reported one-month mortality [ 9 , 10 , 12 , 15 , 19 , 21 , 24 ], three studies reported in-hospital mortality [ 13 , 14 , 22 ], and one study investigated ICU mortality [ 17 ]. Five studies did not report any data in this regard [ 11 , 16 , 18 , 20 , 23 ]. The population in the two studies was septic children [ 16 , 20 ] and in 14 studies were adult septic patients [ 9 – 15 , 17 – 19 , 21 – 24 ].…”

“…The population in the two studies was septic children [ 16 , 20 ] and in 14 studies were adult septic patients [ 9 – 15 , 17 – 19 , 21 – 24 ]. Seven studies were retrospective [ 9 – 11 , 17 , 18 , 20 , 22 ], and nine were prospective [ 12 – 16 , 19 , 21 , 23 , 24 ]. The quality of the studies was high, with scores ranging from 7 to 9.…”

“…Figure 4 shows the subgroup analysis according to the study design. We found seven retrospective studies [ 9 – 11 , 17 , 18 , 20 , 22 ], including 1419 septic patients with 692 survivors and nine prospective studies [ 12 – 16 , 19 , 21 , 23 , 24 ] including 984 septic patients with 557 survivors. Nonsurvivors had elevated levels of PLR compared to survivors in either retrospective (SMD = 0.35, 95% CI = 0.02-0.67, p = 0.035) or prospective studies (SMD = 1.10, 95% CI = 0.35-1.84, p = 0.004).…”

“…Figure 6 presents the final subgroup analysis according to race, including eight studies on white people [ 9 – 11 , 13 , 14 , 17 , 18 , 21 ] with 1610 patients including 738 survivors and eight studies on East Asian people [ 12 , 15 , 16 , 19 , 20 , 22 – 24 ] with 793 patients including 511 survivors. PLR levels were higher among nonsurvivors compared to survivors in the East Asian group (SMD = 0.72, 95% CI = 0.35-1.10, p = 0.001) but not in the white group (SMD = 0.14, 95% CI = −0.00-0.27, p = 0.052).…”