PROGNOSTIC VALUE OF THE NEUTROPHIL-TO-LYMPHOCYTE RATIO IN ACUTE PESTICIDE POISONING

Abstract

Background: Neutrophil to Lymphocyte ratio is a marker of oxidative stress and inflammation. It has gained increased attention in last few years for its prognostic value in several disease subsets. However, there is limited data about its potential role in setting of pesticide poisoning. This study aimed to explore the predictive value of NLR for severe clinical outcome in patients with acute pesticide poisoning. Methods: An observational study was done at medical ICU of Chitwan Medical College from October 2022 to March 2023 among 62 patients of acute pesticide poisoning. The primary endpoint was severe clinical outcome which was defined as a composite of requirement of mechanical ventilation, need for vasopressors, new renal replacement therapy, or in- hospital mortality. The study patients were divided based on patients with severe clinical outcome(n=13) and those without (n=49) for analysis. Results: The NLR ratio at hospital admission in patients with severe clinical outcome and those without were 2.8(1.9-5.9) and 3.3(2.6-11.6) respectively, higher in severe clinical outcome group but the difference was not statistically significant. The NLR had an area under receiver operating characteristics curve of 0.631 (95% confidence interval [CI], 0.472 to 0.790). NLR at hospital admission with a cut-off value ≥ 2.68 predicted severe clinical outcome with 76.9% sensitivity and 55% specificity. Conclusions: The NLR at hospital admission had sub-optimal prediction ability for severe clinical outcome in this study setting. Thus, this cannot be used solely for early identification of patients at risk of severe clinical outcome in acute pesticide poisoning.