Abstract
Background/aimWhile C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis, it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsis patients in the intensive care unit (ICU).Materials and methodsIn this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic health evaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data, antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve (AUC) were calculated for the inflammatory markers and ICU severity scores for mortality.ResultsOf the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock, 330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR and CRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patients when compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality odds ratio was 6.96 (CI: 1.4–34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78, respectively) showed a similar increasing trend for mortality.ConclusionThe NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLR is >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.
Highlights
Recognition of sepsis can lead to early treatment and a potential reduction in septic shock development [1]
Materials and methods: In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of intensive care unit (ICU) stay, and subgrouped according to mortality
Patients admitted to the ICU had pulmonary sepsis and septic shock that was either community acquired pneumonia or acute exacerbation of chronic obstructive pulmonary disease
Summary
Recognition of sepsis can lead to early treatment and a potential reduction in septic shock development [1]. Despite treatment improvements with the global sepsis campaign, patients with septic shock have a high mortality rate in the intensive care unit (ICU) [2,3,4]. Acute physiological and chronic health evaluation II (APACHE) and sequential organ failure assessment (SOFA) scores are well known mortality predictors in ICU patients with sepsis [5,6]. C-reactive protein (CRP) and procalcitonin are the most studied inflammatory. There are some inflammatory markers, such as the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), that are used to assess treatment response in sepsis patients for their simplicity [12,13].
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