Delta de índice neutrófilo linfocitario como marcador de mortalidad en pacientes con diagnóstico de choque séptico en unidad de cuidados intensivos

Abstract

IntroductionShock is the maximum expression of circulatory failure in sepsis that directly affects the survival of patients in intensive care units. One of the main objectives of intensive therapies is to identify patients with a high risk of mortality by searching for reproducible prognostic markers with high sensitivity and specificity, non-invasive, and with good cost-benefit. In this context, neutrophil-to-lymphocyte ratio (NLR) measured over a time range (Delta) could be a probable marker of risk of mortality. ObjectiveTo determine if there is an association between the neutrophil-to-lymphocyte ratio meaured over time [delta (Δ)] with mortality in patients with septic shock. Material and methodsA prospective, descriptive, and observational study was conducted from January to December 2019 in patients with septic shock admitted to the intensive care unit. Serial laboratory measurements and clinical parameters were performed from admission, 12 hours, and 24 hours of hospital stay, with 30-day mortality monitoring. The variables were compared using ANOVA and Youden Index tests. ResultsA total of 64 patients (28 women [44%] and 36 [56%] men) with a mean age of 54.4 years were included. Systematic measurements (192) were made on 3 occasions (192 measurements). The overall mortality at 30 days was 42.18%. The Δ NLR measured from 12 to 24 hours was statistically significant for mortality (p=.007, standard error: 27.85, 95% confidence interval 43.94-152.85). Delta NLR survival curves were associated with 30-day mortality when the delta percentage was greater than zero. ConclusionsPercentage values greater than zero of the delta neutrophil-to-lymphocyte ratio from 12 to 24 hours were related to higher mortality in patients with septic shock.