Predictive value of neutrophil-to-lymphocyte and platelet ratio in in-hospital mortality in septic patients.

BACKGROUND: Among critically ill patients in the intensive care unit (ICU), sepsis is an urgent global public health problem due to its high incidence, high mortality rate and complex pathogenesis.

OBJECTIVE: This study was to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR), and neutrophil-to-lymphocyte and platelet ratio (NLPR) in-hospital mortality in septic patients on days 1, 3 and 5 in ICU.

METHODS: The data of septic patients admitted to the ICU of the Sixth Affiliated Hospital of Sun Yat-sen University from March, 2018 to July, 2019 were collected. NLR and NLPR were calculated and multivariate logistic regression analysis was performed to identify the relationship between them and in-hospital mortality, respectively. Receiver operating characteristic curve (ROC) was used to determine the efficacy and optimal cutoff value of diagnostic tests.

RESULTS: A total of 173 septic patients were included in this analysis, including 108 cases in the survival group and 65 in the death group, with a total mortality rate of 37.6%. A multivariate logistic regression analysis showed that NLR on day 5 was independently correlated with in-hospital mortality rate (OR 1.041, 95% CI: 1.008-1.074), and Day 5 NLPR was also independently associated with in-hospital mortality rate (OR 1.020, 95% CI: 1.001-1.040). The areas under the receiver operating characteristic curve (AUC) of the NLR on days 1 and 3 was 0.513 and 0.542 respectively, and the optimal cutoff value were 23.16 and 15.48, and the AUC of the NLR on day 5 was 0.589, and the best cutoff value was 15.85. The AUC of NLPR on day 1 and 3 was 0.517 and 0.547, respectively, and the optimal cutoff value was 10.25 and 18.47. The AUC of NLPR on day 5 was the largest, 0.654, and the optimal cutoff value was 8.22. After combined NLPR on day 5 with age and sequential organ failure assessment (SOFA) scores, the AUC increase to 0.718. Among the joint predictors, the optimal cutoff value for NLPR on day 5 was 9.31.

CONCLUSION: We found that Day 5 NLPR and NLR were independently correlated with in-hospital mortality. Day 5 NLPR Combined with age and SOFA scores may be help predict mortality in ICU septic hospitalized patients.