Neutrophil-lymphocyte Count Ratio Research Articles

The sensitivity and specificity of neutrophil lymphocyte count ratio in diagnosing sepsis patients at Dr. Saiful Anwar General Hospital, Malang, Indonesia

Background: Sepsis is the most severe manifestation of acute infection which can cause death in 30-50% of cases. Rapid and accurate diagnosis of sepsis is a challenge for clinicians and laboratories. Neutrophil Lymphocyte Count Ratio is a potential index to detect the occurrence of sepsis. This examination is easy, fast and cheap. Procalcitonin is currently widely used as a newer indicator in diagnosing pre-shock but is rarely done because of its cost. This study aims to compare the diagnostic value of Neutrophil Lymphocyte Count Ratio with procalcitonin as a marker in septicpatients.Method: A Case-control analytic research was conducted from March to June 2018. Examination of neutrophils and lymphocytes using Sysmex XN-1000 while procalcitonin examination used Elecsys BRAHMS PCT using ECLIA method. Diagnostic values are analyzed using the ROC curve, and the cut-off value is determined. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy are calculated with 2x2 tables.Result: The subjects of the study were 60 patients who hospitalized and examined for procalcitonin with 30 patients diagnosed based on clinical symptoms and SOFA score ≥ two by clinicians as sepsis patients and also 30 control patients. ROC analysis with procalcitonin cut-off values of 2,24 ng / mL obtained a sensitivity of 93%, specificity of 86,7%, PPV of 86,9%, and NPV of 92,4%.. At the cut-off value of Neutrophil Lymphocyte Count Ratio 5,06, there was a sensitivity of 80%, specificity of 76,7%, PPV of 76,9%, and NPV of 79,1%.Conclusion: Procalcitonin has a better diagnostic value than Neutrophil Lymphocyte Count Ratio in diagnosing sepsis.

Association between Neutrophil-Lymphocyte Count Ratio and Matrix Metalloproteinase-9 in Patients with Acute Myocard Infarction

The correlation between metalloproteinase-9 (MMP-9) level and neutrophil-lymphocyte count ratio (NLCR) in AMI patients has not been studied despite the fact that they are both known to predict ventricular remodeling. This study aimed to evaluate the correlation between the MMP-9 level and NLCR in patients with acute myocardial infarction. A cross-sectional study was conducted by recruiting acute coronary syndrome patients (onset within 24 hours) who were admitted to the emergency department in several hospitals around Bandung during October-December 2012. The relationship between the MMP-9 level and NLCR was analyzed using Pearson correlation test. Linear regression analysis was used to measure the strength of NLCR in MMP-9 level prediction. Thirty seven patients aged 55.8 + 11 years old were included in this study with mostly male patients (78%). Seventy-six percents of the sample were ST-elevation myocardial infarct (STEMI) patients with the onset of symptoms of 6 (3-14) hours. The mean lymphocyte-neutrophil ratio was 5.24 (1σ±2.4) and the MMP-9 plasma concentration was 370 (240-530) ng/mL. One-sided Pearson correlation showed a positive correlation between the two variables (r=0.44, p=0.003). The linear regression analysis conceived the formula of MMP-9 = 40.87 (NLCR) + 211.3 which was used to show the relationship between the MMP-9 level and lymphocyte-neutrophil ratio. There was a positive moderate correlation between the MMP-9 level and NLCR in patients with AMI. Linear regression analysis shows that NLCR is the only independent variable to predict the MMP-9 plasma level. Key words: Acute myocardial infarct, left ventricular remodeling, matrix metalloproteinase (MMP)-9, neutrophyl-lymphocyte count Ratio (NLCR) Korelasi Rasio Ne u trofil-Limfosit (NLCR) dengan Kadar Matriks Metaloproteinase- 9 pada Penderita Infark Miokard ium Akut Korelasi antara matriks metaloproteinase- 9 (MMP-9) dan rasio netrofil-limfosit masih belum pernah dipelajari, meskipun kedua variable tersebut diketahui dapat memprediksi remodeling ventrikel kiri. Studi ini bertujuan mengevaluasi korelasi antara kadar MMP-9 dan rasio netrofil-limfosit pada penderita infark miokardium akut. Penelitian dilakukan secara potong lintang menggunakan sampel darah pasien dengan diagnosis kerja infark miokardium akut (IMA) (onset nyeri dada <24 jam) yang diambil dari beberapa rumah sakit di sekitar Kota Bandung dari periode Bulan Oktober–Desember 2012. Hubungan antara kadar MMP-9 dan rasio neutrofil leukosit dianalisis menggunakan uji korelasi Pearson. Analisis regresi linier digunakan untuk mengukur kekuatan pengaruh konsentrasi rasio neutrofil-limfosit pada kadar MMP-9. Sebanyak 37 pasien berusia 55,8 + 11 tahun, dan 78% di antaranya adalah pria menjadi subjek dalam penelitian ini. Tujuh puluh enam persen sampel diantaranya merupakan pasien infark miokardium dengan elevasi ST dengan onset gejala 6 (3–14) jam. Rerata rasio limfosit-neutrofil adalah 5,24 (1σ ±2,4), dan kadar konsentrasi MMP-9 sebesar 370 (240–530) ng/ml. Uji Korelasi Pearson menunjukkan hubungan positif antara kedua variabel tersebut dengan nilai r=0,44 (p=0,003). Dari analisis regresi linier didapatkan rumus MMP-9= 40,87 (NLCR) + 211,3, yang digunakan untuk menunjukkan hubungan antara kadar MMP-9 dan rasio limfosit-netrofil. Terdapat hubungan positif antara kadar MMP-9 dan rasio neutrofil-limfosit pada pasien penderita IMA. Analisis regresi linier menunjukkan bahwa hanya rasio neutrofil-limfosit yang menjadi variabel prediktor independen kadar MMP-9. Kata kunci: Infark neutrofil akut, matriks-metaloproteinase 9 (MMP-9), rasio limfosit-neutrofil, remodeling ventrikel kiri

The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study.

BackgroundEarly diagnosis and treatment has proven to be of utmost importance in the outcome of sepsis patients. We compared the accuracy of the neutrophil-lymphocyte count ratio (NLCR) to conventional inflammatory markers in patients admitted to the Intensive Care Unit (ICU).MethodsWe performed a retrospective cohort study consisting of 276 ICU patients with sepsis and 388 ICU patients without sepsis. We compared the NLCR as well as C-reactive protein (CRP) level, procalcitonin (PCT) level, white blood cell (WBC) count, neutrophil count and lymphocyte count on ICU admission between sepsis and non-sepsis ICU patients. To evaluate the sensitivity and specificity, we constructed receiver operating characteristics (ROC) curves.ResultsSignificant differences in NLCR values were observed between sepsis and non-sepsis patients (15.3 [10.8–38.2] (median [interquartile range] vs. 9.3 [6.2–14.5]; P<0.001), as well as for CRP level, PCT level and lymphocyte count. The area under the ROC curve (AUROC) of the NLCR was 0.66 (95%CI = 0.62–0.71). AUROC was significantly higher for CRP and PCT level with AUROC’s of 0.89 (95%CI 0.87–0.92) and 0.88 (95%CI 0.86–0.91) respectively.ConclusionsThe NLCR is less suitable than conventional inflammatory markers CRP and PCT to detect the presence of sepsis in ICU patients.Trial registrationClinicalTrials.gov NCT01274819.

Correlation Between Neutrophil-lymphocyte Count Ratio and Procalcitonin in Sepsis and Septic Shock

Sepsis is one of the leading causes of death in patients with infection. Procalcitonin is one of the laboratory parameters that is used to differentiate between thesystemic inflammatory responses caused by pathogens and non-pathogens. Neutrophil-lymphocyte count ratio (NLCR) is one of the simple laboratory parameters used. The purpose of this study was to investigate the correlation between NLCR and procalcitonin for sepsis and septic shock patients. A cross-sectional prospective correlational analysis study was perfromed on 36 sepsis and septic shock patients admitted to the Intensive Care Unit of Dr. Hasan Sadikin Bandung General Hospital during September 2017–May 2018. Statistical analysis was performed using Rank Spearman’s and Mann Whitney test. Both procalcitonin and NLCR increased in sepsis and septic shock patients. Procalcitonin level was significantly different in sepsis and septic shock groups (p&lt;0.05), albeit insignificant difference in NLCR (p&gt;0.05). NLCR was significantly higher in gram positive bacteria patient group (p&lt;0,05); however, the difference was not seen for procalcitonin level (p&gt;0.05). Correlation test found a significant positive correlation between SOFA score and procalcitonin (R=0.557 and p&lt;0.01) and no correlation between SOFA score and NLCR (R=0.117 and p&gt;0.05). There was no correlation between NLCR and procalcitonin for sepsis and septic shock patients (R=0.122 and p&gt;0.05). Therefore, no correlation was found between NLCR and procalcitonin for sepsis and septic shock patients. Korelasi antara Rasio Hitung Neutrofil-Limfosit dan Prokalsitonin pada Pasien Sepsis dan Syok Sepsis Sepsis merupakan salah satu penyebab kematian terbanyak pada pasien infeksi. Pemeriksaan prokalsitonin merupakan salah satu parameter untuk membedakan bahwa respons inflamasi sistemik disebabkan oleh patogen atau non-patogen. Parameter laboratorium lain yang lebih sederhana adalah rasio hitung neutrofil-limfosit (neutrophil-lymphocyte count ratio/NLCR). Tujuan penelitian ini mengetahui korelasi antara NLCR dan prokalsitonin pada pasien sepsis dan syok sepsis. Penelitian analisis korelasional prospektif ini dilakukan dengan desain potong lintang terhadap 36 pasien sepsis dan syok septik yang dirawat di ICU Rumah Sakit Dr. Hasan Sadikin Bandung periode September 2017–Mei 2018. Analisis statistik menggunakan Uji Rank Spearman dan Mann Whitney. Kadar prokalsitonin dan NLCR meningkat pada pasien sepsis dan syok septik. Kadar prokalsitonin berbeda secara signifikan pada kelompok sepsis dan syok septik (p&lt;0,05), perbedaan tidak terlihat untuk NLCR (p&gt;0,05). NLCR secara signifikan lebih tinggi pada bakteri gram positif daripada bakteri gram negatif (p&lt;0,05), perbedaan tidak terlihat pada kadar prokalsitonin (p&gt;0,05). Uji korelasi menunjukkan korelasi positif yang signifikan antara skor SOFA dan prokalsitonin (R=0,557; p&lt;0,01) dan tidak terdapat korelasi antara skor SOFA dengan NLCR (R=0,117; p&gt;0,05). Tidak terdapat korelasi antara NLCR dan prokalsitonin pada pasien sepsis dan syok septik (R=0,122; p&gt; 0,05). Simpulan: tidak terdapat korelasi antara NLCR dan prokalsitonin pada pasien sepsis dan syok septik.

Diagnostic value of biomarkers for sepsis in adult patients in the emergency department: Don't forget the neutrophil-lymphocyte count ratio

Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P

Comparison of the use of neutrophil: lymphocyte count ratio (NLCR) to total leukocyte count in diagnosing appendicitis in adults with right iliac fossa pain

Introduction: Diagnosis of acute appendicitis (AA) is purely based on history, examination and few laboratory investigations. However, it is often a perplexing diagnostic problem during the early stages of the disease. Failure to make an early diagnosis is a primary reason for morbidity and mortality. Elevated leukocyte count is one of the indicators of appendiceal inflammation in patients with right iliac fossa pain and most of the patients with acute appendicitis present with leucocytosis. Recently, it has been seen that the neutrophil: lymphocyte count ratio (NLCR) is a more sensitive marker than leukocytosis in patients with acute appendicitis.&#x0D; Method: This is a prospective observational study conducted over a period of one year in the department of surgery at the Tribhuvan University Teaching Hospital, from September 2013 to August 2014. The clinical diagnosis of Acute appendicitis was made by history and clinical examinations and laboratory investigations. Total leukocyte count (TLC) and NLCR of patients diagnosed as AA were measured and recorded in the pro forma. Histological diagnosis was taken as the final diagnosis.&#x0D; Results: A total of 106 patients were included in the study. Two third of the patients were male. Right iliac fossa tenderness was the most common sign. Ultrasound was able to diagnose acute appendicitis in 40.65% of the cases. NLCR&gt; 3.5 was observed in 90.56% of patients with acute appendicitis, whereas 78.3% of patients had leukocytosis only. High NLCR (5.60) is associated with complicated AA.&#x0D; Conclusion: NLCR is a more sensitive laboratory parameter than TLC in patients with RIF pain to diagnose acute appendicitis. A high NLCR ratio has a high likelihood of a complicated AA.

The neutrophil-lymphocyte count ratio as a diagnostic marker for bacteraemia: A systematic review and meta-analysis

BackgroundBacteraemia is a common cause of increased morbidity and mortality in critically ill patients, but its early diagnosis and identification are complicated. The neutrophil-lymphocyte count ratio (NLCR) has been suggested as a useful indicator for the diagnosis of bacteraemia. We performed this meta-analysis to investigate the diagnostic accuracy of the NLCR for bacteraemia. MethodsWe searched the PubMed, Embase, Web of Science, and Cochrane Library databases for this meta-analysis. We calculated individual and pooled sensitivities and specificities. I2 statistics and Cochran's Q test were used to evaluate heterogeneity, and the cause of heterogeneity was explored with sensitivity analyses. ResultsIn total, 8 of 1086 eligible articles were included in the present meta-analysis. The pooled analyses revealed that the diagnostic accuracy of the NLCR in terms of its bacteraemia sensitivity was 0.723 [95% CI: 0.660, 0.777], and its specificity was 0.596 [95% CI: 0.556, 0.634]. The area under the summary receiver operating characteristic curve was 0.69 [95% CI 0.65–0.73]. ConclusionThe NLCR is an easy-to-collect marker for bacteraemia. However, the NLCR is inadequate, and only a combination of multiple biomarkers will improve its diagnostic accuracy for bacteraemia.

Calprotectin and calgranulin C serum levels in bacterial sepsis

The aim of this study was to evaluate the serum levels of calprotectin and calgranulin C and routine biomarkers in patients with bacterial sepsis (BS). The initial serum concentrations of calprotectin and calgranulin C were significantly higher in patients with BS (n = 66) than in those with viral infections (n = 24) and the healthy controls (n = 26); the level of calprotectin was found to be the best predictor of BS, followed by the neutrophil-lymphocyte count ratio (NLCR) and the level of procalcitonin (PCT). The white blood cell (WBC) count and the NLCR rapidly returned to normal levels, whereas PCT levels normalized later and the increased levels of calprotectin, calgranulin C, and C-reactive protein persisted until the end of follow-up. Our results suggest that the serum levels of calprotectin are a reliable biomarker of BS and that the WBC count and the NLCR are rapid predictors of the efficacy of antimicrobial therapy.

Neutrophil-Lymphocyte count ratio on admission as a predictor of Bacteremia and In Hospital Mortality among Sepsis and Septic shock In Patients at Rizal Medical Center

Background: Neutrophil-Lymphocyte count ratio (NLCR), a readily accessible biomarker, has become increasingly useful as predictive and prognostic tools in patients with various medical conditions. NLCR has also been reported to represent disease severity effectively.Aims and Objectives: To investigate NLCR on admission as a prognostic marker of bacteremia and in-hospital mortality in patients diagnosed with Sepsis and Septic Shock.Materials and Methods: This cross-sectional, retrospective study involves one-hundred twenty (120) adult patients with Sepsis and Septic Shock admitted to the IMCU and ICU from January 2015 to December 2016. Laboratory data and clinical outcomes were retrieved and documented from the laboratory and patients’ charts. A cut-off point of &gt;10 was used to be a marker for bacteremia and hence, patients were stratified into two groups based on this cut-off. Out of 120, 78 patients (with mean age of 60) has NLCR of at least 10 while only 42 patients (with mean age of 55) has NCLR of at most 10.Results: A significant, strong and positive association between NLCR and in-hospital mortality was found (P=0.0001) indicating that an increased rate of mortality is observed for patients with persistently high NCLR. Results also indicated that NLCR is a significant predictor (P=0.0002) of in-hospital mortality via a logistic model. The receiver-operating characteristic (ROC) curve for NLCR predicting in-hospital mortality showed an area under the curve (AUC) of 0.8007 which is an indicative of high predictive power. Its sensitivity and specificity is calculated to be 97.37% and 93.18, respectively. Overall, the performance of NCLR as a predictor based on its computed hit rate is found to be approximately 93.33%.Conclusion: Increased NLCR levels were independently associated with unfavorable clinical prognosis in patients with sepsis. A high NLCR (&gt;10) is significantly associated with in- hospital mortality. NCLR predicts in-hospital mortality with high accuracy, high precision and small misclassification.Asian Journal of Medical Sciences Vol.9(3) 2018 6-9

Correlation between the neutrophil-lymphocyte count ratio and bacterial infection in patient with human immunodeficiency virus

Parameters for starting antibiotic therapy such as CRP andleukocytosis are considered non-specific. Previous studies have shown the Neutrophil-Lymphocyte Count Ratio (NLCR) can serve as the basis of bacterial infection, the level of infection, and the basis of antibiotic therapy. Compared with the Procalcitonin parameter, this NLCR is rapid, an inexpensive and requires no additional sampling. To determine the correlation between The Neutrophil-LymphocyteCount Ratio to bacterial infection in HIV patients. This study was a cross-sectional observational approach to HIV subject at Wahidin Sudirohusodo and Hasanuddin University Hospital. The subjects performed routine blood, microbiology test,and blood Procalcitonin levels tests. Then performed NLCR calculations based on routine blood results. The subjects then grouped the presence or absence of bacterial infection.In 146 study subjects, there were 78 (53.4%) with bacterial infections and 68 (46.6%) without bacterial infection as controls. Subjects with bacterial infections had higher total neutrophils (84.83) compared with non-bacterial infections. Subjects with bacterial infections had total lymphocytes with an average of 8.51 lower than non-bacterial infections. Subjects with bacterial infections had higher NLCR values with an average of 12.80. The Neutrophil-Lymphocyte Count Ratio can become a marker of bacterial infection in HIV patients.

The Eminence of Neutrophil-lymphocyte Count Ratio in Predicting Bacteremia for Community-acquired Infections at an Emergency Medicine Department in a Tertiary Care Setting.

Introduction:The changes in the white blood cells counts and other blood parameters are well-recognized feature in sepsis. A ratio between neutrophils and lymphocytes can be used as a screening marker in sepsis. Even though new markers such as Procalcitonin and adrenomedullin have been rolled out in the field, implementation of these markers has been hindered by cost, accessibility, and proper validation. We looked for the ability of simple neutrophil-lymphocyte count ratio (NLCR) when compared to the gold standard blood culture method in predicting bacteremia, on patients presented to emergency department (ED) with features of suspected community-acquired infections.Materials and Methods:A comparative study done on 258 adult patients, admitted with suspected features of community-acquired infections. The study group included all patients who had positive blood culture results on index presentation at ED. Patients with hematological, chronic liver and retroviral diseases, patients receiving chemotherapy, and steroid medications were excluded from the study. The study group was compared with gender- and age-matched control group who were also admitted with a suspicion of the same, but in whom the blood culture results were negative.Results:There was no statistically significant difference for predicting bacteremia by NLCR (>4.63) and culture positivity methods (P = 1.00). NLCR of > 4.63 predicts bacteremia with an accuracy of 84.9%.Conclusion:In our setting, NLCR performs equally well with culture positivity, in detecting severe infection at the early phase of disease. The NLCR may, therefore, be used as a suitable screening marker at ED for suspected community-acquired infections.

Pre-operative neutrophil count and neutrophil-lymphocyte count ratio (NLCR) in predicting the histological grade of paediatric brain tumours: a preliminary study

IntroductionThe neutrophil-lymphocyte count ratio (NLCR) is an established prognostic marker for renal, lung and colorectal carcinomas and has been suggested to be predictive of histological grade and outcome in adult intracranial tumours. The purpose of this study was to determine whether a correlation of the pre-operative neutrophil count (NC) and NLCR with the final histological grade exists in paediatric intracranial tumours.MethodsA retrospective analysis was undertaken at a single centre. Patients less than 18 years old at the time of surgery who underwent tumour-related procedures from 2006 to 2015 were included. Patients with recurrent tumours, previous bone marrow transplant and metastases were excluded. Pre-operative full blood counts (FBC), collected before the diagnosis of intracranial pathology and before administration of steroids, were matched with histological diagnosis for each patient. Post-operative FBC was also recorded, together with survival data where applicable.ResultsA total of 116 patients (74 male, 42 female; mean age, 8 ± 0.9 years) with a diagnosis of primary intracranial tumours had pre-operative FBC that could be matched to final histological grade. Pre-operative NC and NLCR were higher with increasing grade of tumour: grade 1 (NC 4.29 109/l, NLCR 2.26), grade 2 (NC 4.59 109/l, NLCR 2.38), grade 3 (NC 5.67 109/l, NLCR 2.72) and grade 4 (NC 6.59 109/l, NLCR 3.31). Patients with WHO grade 1 and 2 tumours pooled together had a lower NC (4.37 95% CI ± 0.67 109/l) compared to WHO grade 3 and 4 patients (6.41 95% CI ± 0.99 109/l, p = 0.0013). The NLCR was lower in grade 1 and 2 tumours (2.29 ± 0.59) (compared to grade 3 and 4 tumours; 3.20 ± 0.76) but this did not reach significance (p = 0.069). The subgroup of patients with pilocytic astrocytoma had a significantly lower NC when compared to patients with high-grade tumours (p = 0.005). Medulloblastoma and supratentorial PNET subgroups had significantly higher NC compared to the low-grade group (p = 0.033, p = 0.002). Post-operative NC was significantly higher in the high-grade tumours (p = 0.034), but no difference was observed for NLCR (p = 0.28).ConclusionsNo evidence exists to support the correlation of pre-operative NC or NLCR to histological diagnosis in paediatric intracranial tumours. Our results indicate that a higher pre-operative NC/NLCR correlates with a higher histological grade of tumour. This suggests that immunological mechanisms may be involved in the pathogenesis of paediatric brain tumours, and a further prospective study is required to substantiate and expand these findings.

Usefulness of Various Peripheral Blood Leukocyte Count ratios in Malaria Evaluation

Malaria is a major public health problem in India. Changes in blood cell counts are a wellknown feature of malaria. Hence an attempt has been made to assess the role of leucocyte ratios in malaria as predictors of malaria infection and its clinical severity. Methods: A retrospective observational cohort study was carried out in a tertiary care teaching hospital over a period of 2 months. A total of 171 samples and 48 controls were included in the study. All the absolute and differential white blood cell counts were done. The neutrophillymphocyte count ratio (NLCR), monocyte-lymphocyte count ratio (MLCR) and monocyteneutrophil count ratio (MNCR) were calculated by using the absolute neutrophil, lymphocyte and monocyte count respectively. The results were analyzed statistically using SPSS software for windows. Results: Among 171 cases 145(84.8%), 19(11.1%), 7(4.1%) were Pl. vivax, Pl. falciparum and mixed malaria respectively. 52 cases were severe and 119 were non-severe. 52, 45, 47, 27 were parasitemia grade 1, 2, 3, 4 respectively. NLCR, MLCR and MNCR showed a sensitivity of 60.8%, 71.7%, 70.8% and specificity of 43.8%, 60.4%, and 56.3% respectively in malaria diagnosis. There was no association of NLCR, MLCR, MNCR with the type and severity of malaria. NLCR, MNCR correlated with varying grade of parasitemia. Conclusion: The results show the ratios NLCR, MLCR and MNCR have a better sensitivity but less specificity. The sensitivity and specificity for MLCR are the highest and can be used as a supportive to a screening test. The ratios can be used to show the presence of malaria parasite but there is no association with the type and severity of malaria. MLCR is a good predictor of malarial presence. NLCR and MNCR are associated with parasitemia.

The Importance of Haemogram Parameters in the Diagnosis and Prognosis of Septic Patients.

Sepsis represents a severe pathology that requires both rapid and precise positive and differential diagnosis to identify patients who need immediate antimicrobial therapy. Monitoring septic patients’ outcome leads to prolonged hospitalisation and antibacterial therapy, often accompanied by substantial side effects, complications and a high mortality risk.Septic patients present with complex pathophysiological and immunological disorders and with a predominance of pro-inflammatory or anti-inflammatory mediators which are heterogeneous with respect to the infectious focus, the aetiology of sepsis or patients’ immune status or comorbidities. Previous studies performed have analysed inflammatory biomarkers, but a test or combinations of tests that can quickly and precisely establish a diagnosis or prognosis of septic patients has yet to be discovered. Recent research has focused on re-analysing older accessible parameters found in the complete blood count to determine the sensitivity, specificity, positive and negative predictive values for the diagnosis and prognosis of sepsis.The neutrophil/lymphocyte count ratio (NLCR), mean platelet volume (MPV) and red blood cells distribution width (RDW) are haemogram indicators which have been evaluated and which are of proven use in septic patients’ management.

Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis.

BackgroundEarly recognition is a key factor to achieve improved outcomes for septic patients. Combinations of biomarkers, as opposed to single ones, may improve timely diagnosis and survival. We investigated the performance characteristics of sepsis biomarkers, alone and in combination, for diagnosis of verified bacterial sepsis using Sepsis-2 and Sepsis-3 criteria, respectively.MethodsProcalcitonin (PCT), neutrophil-lymphocyte count ratio (NLCR), C-reactive protein (CRP), and lactate were determined in a total of 1,572 episodes of adult patients admitted to the emergency department on suspicion of sepsis. All sampling were performed prior to antibiotic administration. Discriminant analysis was used to construct two composite biomarkers consisting of linear combinations of the investigated biomarkers, one including three selected biomarkers (i.e., NLCR, CRP, and lactate), and another including all four (i.e., PCT, NLCR, CRP, and lactate). The diagnostic performances of the composite biomarkers as well as the individual biomarkers were compared using the area under the receiver operating characteristic curve (AUC).ResultsFor diagnosis of bacterial sepsis based on Sepsis-3 criteria, the AUC for PCT (0.68; 95% CI 0.65–0.71) was comparable to the AUCs for the both composite biomarkers. Using the Sepsis-2 criteria for bacterial sepsis diagnosis, the AUC for the NLCR (0.68; 95% CI 0.65–0.71) but not for the other single biomarkers, was equal to the AUCs for the both composite biomarkers. For diagnosis of severe bacterial sepsis or septic shock based on the Sepsis-2 criteria, the AUCs for both composite biomarkers were significantly greater than those of the single biomarkers (0.85; 95% CI 0.82–0.88 for the composite three-biomarker, and 0.86; 95% CI 0.83–0.89 for the composite four-biomarker).ConclusionsCombinations of biomarkers can improve the diagnosis of verified bacterial sepsis in the most critically ill patients, but in less severe septic conditions either the NLCR or PCT alone exhibit equivalent performance.

Role of eosinophil count and neutrophil: lymphocyte count ratio as prognostic markers in patients with sepsis

Background: Several biomarkers, such as C-reactive protein (CRP) and Procalcitonin have been used to indicate bacterial infection in sepsis. They have limited sensitivity and specificity with high cost, placing them practically out of reach for poor patients in developing countries like India. Hence the need to evaluate eosinophil count and neutrophil-lymphocyte count ratio (NLCR) as an indicator of sepsis considering their lower cost and easier accessibility. The present study was done to establish that eosinopenia and the neutrophil-lymphocyte count are simple and effective tools as prognostic biomarkers for sepsis.Methods: A prospective observational study consisting of 50 patients with SIRS and sepsis on admission were studied. Neutrophil and lymphocyte count for first 4 consecutive days and then on alternate days up to one week was done. Absolute eosinophil count for first 2 consecutive days and then on alternate days up to one week was done.Results: Eosinopenia was noted to have 79.3% sensitivity, 76.2% specificity, positive predictive value 82.2% and negative predictive value 95.4% in predicting diagnosis and prognosis of sepsis. Neutrophil-lymphocyte ratio was found to have 86.2% sensitivity, 85.7% specificity, positive predictive value of 89.2%, negative predictive value of 81.1% in predicting diagnosis and prognosis of sepsis.Conclusions: Eosinophil count and neutrophil - lymphocyte count ratio are simple and effective prognostic markers of sepsis with low cost.

The prognostic and risk-stratified value of neutrophil–lymphocyte count ratio in Chinese patients with community-acquired pneumonia

Community-acquired pneumonia is a common disease associated with high mortality. This retrospective study examined whether the neutrophil–lymphocyte count ratio (NLR), already widely used as an index of inflammation, can be used to predict in-hospital mortality of adults with community-acquired pneumonia. Clinical characteristics, CURB-65 and pneumonia severity index score of pneumonia severity, NLR, serum levels of C-reactive protein and procalcitonin, and in-hospital mortality were analyzed for 318 consecutive adults with community-acquired pneumonia admitted to West China Hospital between July 2012 and December 2013. The ability of NLR and other parameters to predict in-hospital mortality was assessed using receiver operating characteristic (ROC) curves. Results showed that NLR increased with increasing CURB-65 ( P &lt; 0.05) and pneumonia severity index ( P &lt; 0.05), and NLR correlated positively with serum levels of C-reactive protein (r = 0.239, P &lt; 0.05) and procalcitonin (r = 0.211, P &lt; 0.05). The median value of NLR was significantly higher among patients who died in hospital (11.96) than among those who were alive at the end of hospitalization (4.19, P &lt; 0.05). Based on a cut-off NLR of 7.12, this index predicted in-hospital mortality with a sensitivity of 82.61% and specificity of 72.20% (area under ROC curve, 0.799). Predictive power was greater for the combination of NLR and serum levels of C-reactive protein and procalcitonin. These results suggest that NLR may be useful for predicting prognosis in Chinese adults with community-acquired pneumonia, and it may work better in combination with traditional markers.

Pediatric central nervous system tumors in the first 3years of life: pre-operative mean platelet volume, neutrophil/lymphocyte count ratio, and white blood cell count correlate with the presence of a central nervous system tumor.

The aim of this study is to describe the relationship of pre-operative complete blood count parameters [mean platelet volume (MPV), neutrophil/lymphocyte count ratio (NLCR), and white blood cell count (WBC)], with the clinical, radiological, and histopathological features and the management options for patients under 3years of age with a newly diagnosed central nervous system tumors. Children with central nervous system (CNS) tumors in the first 3years of life admitted in the Erciyes University Hospital between April 2004 and April 2014 were enrolled in this study. The CBC parameters were compared with those of an age- and sex-matched normal control group. In the study group, the means of MPV and WBC were 8.00±1.24fl, and 10,855±3642/mm3 respectively; the median (25-75%) of NLCR was 0.98 (0.66-1.46). For the control group, the means of MPV and WBC were 6.8±0.73fl and 8565±2522/mm3; the median (25-75%) of NLCR was 0.52 (0.36-0.70). The MPV, WBC, and NLCR were higher in the study group. The median overall survival (OS) of the patients was 60months (range 0-81.6months); and median event free survival (EFS) was 24months (range 0-70.1months). The formulation of MPV, NLCR, and WBC was found to be predictive for the diagnosis of CNS tumor in children with nonspecific symptoms. The univariate and multiple binary regression analyses showed a positive association of MPV, NLCR, and WBC and the risk of a diagnosis of CNS tumor. There was no relationship between MPV, WBC, NLCR, and histological subgroups. However, there were no associations between CBC parameters and OS or EFS of the patients. By causing suspicion, MPV, NLCR, and WBC may provide both an earlier radiological investigation decision and thereby an early diagnosis of CNS tumor in children with nonspecific symptoms in the first 3years of life.

Platelet-lymphocyte ratios: a potential marker for pulmonary tuberculosis diagnosis in COPD patients.

BackgroundIn recent decades, morbidity and mortality have been found to be significantly increased in patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary tuberculosis (PTB). Platelet–lymphocyte ratio (PLR) is an indicator for inflammatory diseases. This study aims to investigate whether PLR could act as a potential marker for patients with COPD complicated with PTB.MethodsIn this retrospective study, laboratory characteristics of 87 COPD patients complicated with PTB (determined by Mycobacterium tuberculosis positive culture from sputum or bronchial lavage fluid) and 83 COPD patients (as the control group, determined by M. tuberculosis culture negativity from sputum or bronchial lavage fluid) were investigated. Data obtained on the day of admission were analyzed.ResultsPLR >216.82 was identified as the optimal cutoff value for discriminating COPD patients with PTB (sensitivity 92.4%, specificity 84.5%, positive-predictive value 91.6%, negative-predictive value 86.2%, and area under the curve [AUC] was 0.87) from patients with COPD alone. The AUC of PLR was significantly greater than that of neutrophil–lymphocyte count ratio (AUC, 0.74; 95% confidence interval, 0.67–0.81; P<0.01).ConclusionPLR could be developed as a valuable maker for identifying tuberculosis infection in COPD patients.

Significance of preoperative neutrophil–lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy

We evaluated the usefulness of preoperative neutrophil–lymphocyte count ratio (NLCR) in predicting postoperative sepsis after percutaneous nephrolithotomy (PCNL). In total, 487 patients who underwent PCNL for renal stones were included in the present retrospective study. The stone burden, number of tracts and location, operation time, fluoroscopy time, presence of residual stones, and blood transfusion rates were postoperatively recorded in all patients. All patients were followed up for signs of systemic inflammatory response syndrome (SIRS) and sepsis. The association of sepsis/SIRS with the risk factors of infectious complications, including NLCR, was evaluated. SIRS was detected in 91 (18.7%) patients, 25 (5.1%) of whom were diagnosed with sepsis. Stone burden, operation time, irrigation rate, previous surgery, nephrostomy time, access number, blood transfusion, residual stone, postoperative urinary culture, renal pelvis urinary culture, and stone culture were found to be predictive factors for SIRS and sepsis development. Receiver operating characteristic curve analysis revealed an NLCR cutoff of 2.50 for predicting the occurrence of SIRS/sepsis. We found that the incidence of sepsis was significantly higher in patients with NLCR ≥ 2.50 than in patients with NLCR < 2.50 (p = 0.006). Preoperative and postoperative urine culture positivity were associated with high NLCR (p = 0.039 and p = 0.003, respectively). We believe that preoperative NLCR may be a promising additive predictor of bacteremia and postoperative sepsis in patients who undergo PCNL for renal stones. This marker is simple, easily measured, and easy to use in daily practice without extra costs.