Neutrophil-to-lymphocyte ratio in predicting mortality in sepsis and its correlation with sofa score and C-reactive protein values.

Abstract

Sepsis is one of the leading causes of death worldwide in the critically ill patients. Early diagnosis and stratification of severity play a vital role in management of sepsis. Different biomarkers like C-reactive protein (CRP) and presepsin are available as markers of inflammation. Neutrophil-to-lymphocyte ratio (NLR) is used as a prognostic marker in many inflammatory conditions and cancers, which is cost-effective. To evaluate NLR as a predictor of mortality in sepsis and correlating it with Sequential Organ Failure Assessment (SOFA) score and CRP values. This is a prospective observational study including 100 patients of sepsis. Apart from routine investigations, NLR, SOFA score, and CRP (Q) were determined on days 1, 3, and 5 of hospital admission. Patients were followed up during hospital stay for primary outcome as either death or discharged. The present study included 100 patients, out of which 53% were females and 47% were males. 54% survived in the female group, whereas it was 48.9% in the males. Mortality was the highest in the age group of 41-50 years (63.3%), followed by > 60 years (58.13%). Pneumonia (58%) was the most common cause of sepsis, followed by urinary tract infection (24%). Diabetes (52%) was the most common risk factor, followed by hypertension (36%) and chronic kidney disease (13%). The area under curve (95% confidence interval) of NLR on days 3 and 5 for the prediction of mortality is 75.5% (65.9%-83.5%) and 94.7% (88.3%-98.2%, <i>P</i> = 0.001), respectively, that is, very highly significant. The median of CRP (Q) on day 3 for surviving patients was 57.65 and that for nonsurviving patients was 92.10 (<i>P</i> = 0.005), that is, highly significant. The median of CRP (Q) on day 5 for surviving patients was 38.0 and that for nonsurviving patients was 106.0 (<i>P</i> = 0.001), that is, very highly significant. The median of SOFA score on day 3 for surviving patients was 3 and that for nonsurviving patients was 8 (<i>P</i> = 0.001), that is, very highly significant. The median of SOFA score on day 5 for surviving patients was 2 and that for nonsurviving patients was 11 (<i>P</i> = 0.001), that is, very highly significant. A high value of NLR, SOFA score, and CRP on days 3 and 5 of admission in sepsis patients is associated with increased mortality. A serial increase in the value of NLR during the initial period of sepsis is a better marker for prediction of mortality, rather than a single point value, and the same is true for SOFA score and CRP values. NLR can be used as a simple, cheap, and easily available biomarker for sepsis during the initial period to predict severity and mortality.