Value Of Neutrophil To Lymphocyte Ratio In Assessing Severity And Predicting The Prognosis Of Patients With Sepsis

Objective The purpose of the present study was to evaluate the potential association between NLR and the severity and clinical prognosis of patients with sepsis by dynamic monitoring of the neutrophils to lymphocyte ratio(NLR)and other relative indicators in peripheral blood of patients with sepsis.Methods Hospitalized patients in Dec,2017 to Jun,2018 with sepsis were prospectively enrolled into this study.According to the severity of the patient’s condition,it was divided into sepsis group and septic shock group.Baseline clinical characteristics.All the eligible patients were further divided into survival group and death group according to the 28-day survival.Acute physiology and chronic health evaluation score Ⅱscore(APACHEⅡ),Sequential organ failure assessment score(SOFA)and laboratory characteristics at 1,3 days after admission were collected,compared and analyzed.Receiver operating characteristic(ROC)curves and multivariate logistic regression models were used to evaluate the risk factors of sepsis.Correlations between NLR and APACHEⅡ score,SOFA score were analyzed through Pearson correlation tests.Results1.There was no significant difference between the two groups in sex and underlying conditions(P>0.05);nonsurvivors were significantly older than survivors(P<0.05);In the infected site,the soft tissue infection in the non-survival group was higher than that in the survival group(p<0.05),and the remaining no statistical significance(P>0.05).The survival group had less septic shock than the non-survival group(p<0.05).2.There was no significant difference between the two groups in the number of white blood cell(WBC),platele(PLT),neutrophil(N),lymphocyte(L),NLR and procalcitonin(PCT)at 1 day after admission(P>0.05).p H,lactate(Lac),APACHEⅡscore,SOFA score and white blood cell(WBC),neutrophil(N),lymphocyte(L),NLR at 3 days after admission were significantly different between the two groups(P<0.05).3.The receiver operating characteristic curve(ROC curve)analysis showed that the white blood cell(WBC),neutrophil(N),lymphocyte(L),NLR at 3 days after admission had a greater power for predicting unfavorable outcome,and the area under the ROC curve(AUC)were 0.709,0.728,0.731,0.739,0.716,respectively.4.It was shown by multi-factor logistic regression analysis that NLR at 3 days after admission and APACHEⅡ score were the independent predictors of adverse outcome.5.Combined with the 72 h NLR,72 h lymphocyte(L)and APACHEⅡ scores,the area under the ROC curve(AUC)for predicting sepsis mortality was 0.803.The combined marker predicted better prognosis than the single index(72h NLR and APACHEⅡ score).6.Pearson correlation tests showed that there was a positive correlation between24 h white blood cell(WBC)levels and APACHEⅡ score(r=0.251,P=0.004),a positive correlation between 24 h neutrophil(N)and APACHEⅡ score(r=0.267,P=0.002),a negative correlation between 24 h lymphocyte(L)levels and APACHEⅡscore(r=-0.227,P=0.003),a positive correlation between 24 h NLR levels and SOFA score(r=0.262,P=0.002),a positive correlation between SOFA score and APACHEⅡscore(r=0.611,P=0.000).Conclusions1.NLR at 1 days after admission cannot predict mortality in sepsis,while the trend of changes in NLR contributes to prediction of the outcome of patients with sepsis.2.NLR at 3 days after admission and APACHEⅡ score were the independent predictors of adverse outcome of patients with sepsis.3.Combined marker can improve the predicted efficiency of the prognosis of septic patients.4.24 h NLR was positively correlated with disease severity.