Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients

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Introduction. The neutrophil-to-lymphocyte ratio (NLR) as calculated from the white cell differential blood count is a marker that has been used as a prognostic index when assessing patients suffering from several clinical syndromes, including sepsis. The aim of this study was to evaluate the relationship between NLR and the commonly used severity scores of sepsis SOFA, APACHE II and SAPS II in a population of emergency admitted adult patients with sepsis in a tertiary center.

Methods. A prospective observational study was conducted in the Emergency Department of the University Hospital of Patras, Greece, based on data extracted from 50 patients consecutively enrolled, suffering from sepsis of multiple origin. The study period was from May 01, 2017 until June 30, 2017. The NLR was calculated from the total white blood cell (WBC) count values measured from a peripheral venous blood specimen drawn on admission. C-reactive protein (CRP) was also measured. The sepsis severity prognostic scores APACHE II, SAPS II and SOFA were calculated for each patient.

Results. NLR was positively correlated with the sepsis severity prognostic scores on admission (SOFA, rs = 0.497, p < 0.001; APACHE II, rs = 0.411, p = 0.003; SAPS II, rs = 0.445, p = 0.001). Total WBC was also significantly correlated with the scores (SOFA, rs = 0.342, p = 0.015; APACHE II, rs = 0.384, p = 0.006; SAPS II, rs = 0.287, p = 0.043). Serum CRP did not show any significant correlation either to NLR or to the sepsis severity scores on admission.

Conclusions. NLR is an easily calculated, cost-efficient index that could be used as a tool for clinicians when assessing sepsis patients in the Emergency Department. Although NLR measurement is simple, and rapidly available, future and larger prospective studies are warranted to confirm its definite value as a prognostic index in sepsis patients.

1. STEVENSON EK, RUBENSTEIN AR, RADIN GT, WIENER RS, WALKEY AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med 2014; 42: 625-31.

2. KNAUS WA, DRAPER EA, WAGNER DP, ZIMMERMAN JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-29.

3. VINCENT JL, MORENO R, TAKALA J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996; 22: 707-10.

4. LE GALL JR, LEMESHOW S, SAULNIER F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270: 2957-63.

5. HWANG SY, SHIN TG, JO IJ, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017; 35: 234-9.

6. SINGER M, DEUTSCHMAN CS, SEYMOUR CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801-10.

7. PIERRAKOS C, VINCENT J-L. Sepsis biomarkers: a review. Crit Care 2010; 14: R15.

8. MARSHALL JC, REINHART K, INTERNATIONAL SEPSIS FORUM. Biomarkers of sepsis. Crit Care Med 2009; 37: 2290-8.

9. SCHUETZ P, CHRIST-CRAIN M, MÜLLER B. Biomarkers to improve diagnostic and prognostic accuracy in systemic infections. Curr Opin Crit Care 2007; 13: 578-85.

10. BONE RC, FISHER CJ, CLEMMER TP, SLOTMAN GJ, METZ CA, BALK RA. Sepsis syndrome: a valid clinical entity. Methylprednisolone Severe Sepsis Study Group. Crit Care Med 1989; 17: 389-93.

11. HOWELL MD, TALMOR D, SCHUETZ P, HUNZIKER S, JONES AE, SHAPIRO NI. Proof of principle: the predisposition, infection, response, organ failure sepsis staging system. Crit Care Med 2011; 39: 322-7.

12. GUIRGIS FW, PUSKARICH MA, SMOTHERMAN C, et al. Development of a Simple Sequential Organ Failure Assessment Score for Risk Assessment of Emergency Department Patients With Sepsis. J Intensive Care Med 2017: 885066617741284.

13. DESAI S, LAKHANI JD. Utility of SOFA and APACHE II score in sepsis in rural set up MICU. J Assoc Physicians India 2013; 61: 608-11.

14. FUNG YL, FRASER JF, WOOD P, MINCHINTON RM, SILLIMAN CC. The systemic inflammatory response syndrome induces functional changes and relative hyporesponsiveness in neutrophils. J Crit Care 2008; 23: 542-9.

15. NIERHAUS A, KLATTE S, LINSSEN J, et al. Revisiting the white blood cell count: immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis – a prospective, observational study. BMC Immunol 2013; 14: 8.

16. DAHN MS, WHITCOMB MP, LANGE MP, JACOBS LA. Altered T-lymphocyte subsets in severe sepsis. Am Surg 1988; 54: 450-5.

17. LE TULZO Y, PANGAULT C, GACOUIN A, et al. Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome. Shock 2002; 18: 487-94.

18. ZAHOREC R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102: 5-14.

19. AZAB B, BHATT VR, PHOOKAN J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 2012; 19: 217-24.

20. WALSH SR, COOK EJ, GOULDER F, JUSTIN TA, KEELING NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005; 91: 181-4.

21. MUHMMED SULIMAN MAR, BAHNACY JUMA AA, ALI ALMADHANI AA, PATHARE AV, ALKINDI SSA, UWE WERNER F. Predictive Value of Neutrophil to Lymphocyte Ratio in Outcomes of Patients with Acute Coronary Syndrome. Arch Med Res 2010; 41: 618-22.

22. AZAB B, JAGLALL N, ATALLAH JP, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology 2011; 11: 445-52.

23. LIU X, SHEN Y, WANG H, GE Q, FEI A, PAN S. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Patients with Sepsis: A Prospective Observational Study. Mediators Inflamm 2016; 2016: 1-8.

24. DE JAGER CPC, WEVER PC, GEMEN EFA, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One 2012; 7: e46561.

25. LJUNGSTROM L, JACOBSSON G, ANDERSSON R. Neutrophil-lymphocyte count ratio as a biomarker of severe sepsis in Escherichia coli infections in adults. Crit Care 2013; 17: P25.

26. SALCICCIOLI JD, MARSHALL DC, PIMENTEL MAF, et al. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care 2015; 19: 13.

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