Neutrophil to lymphocyte and platelets to lymphocyte ratios as predictive factors of sepsis mortality
DOI:
https://doi.org/10.29166/ciencias_medicas.v44i1.1970Keywords:
Index, neutrophils, lymphocytes, platelets, sepsis, shockAbstract
Background: Although there are several methods to assess the severity and mortality of sepsis based on scales and biomarkers, not all are available in health institutions for their cost
Objective: To determine whether neutrophil / lymphocyte and platelet / lymphocyte indices are adequate predictors of severity and mortality in patients with sepsis and septic shock.
Methods: Analytical observational study in 149 patients with sepsis and septic shock at the Hospital Docente de Calderón, Quito. Diagnosis of sepsis and septic shock according to SEPSIS 3 criteria, and its severity by means of Sequential Organic Failure Assessment (SOFA) and Acute Physiology and Chronic Health II (APACHE II). Indices between neutrophils-lymphocytes (INL) and platelets-lymphocytes (IPL) were calculated. The predictive mortality range of each index was established using adjusted Odd radios (multiple logistic regression) and areas under the curve (AUC) ROC (Receiver Operating Characteristic).
Results: The APACHE II median was 17 ± 7 points, the SOFA median was 8 ± 4 points, and the mortality rate was 33.6%. Regarding mortality, INL with a cut-off point of ≥13.2 presented OR =1.03, AUC of 0.53, sensitivity of 47.1%, and specificity of 48.4%. IPL with a cut-off point of ≥221.8 presented an OR =1.002 (95% CI 0.999-1.003), AUC of 0.56, sensitivity of 47.1%, and specificity of 48.4%
Conclusions: Neutrophil / lymphocyte and platelet / lymphocyte indices are tests with low predictive power to assess the severity and mortality of patients with sepsis and septic shock.
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References
Singer M, Deutschman C, Seymour C, Shankr M, Annane D, et a. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810.
Seymour C, Liu V, Iwashyna T, Brunkhorst W, Rea T, Scherag A, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315(8):762-774
Armstrong B, Betzold R, May A. Sepsis and septic shock strategies. Surg Clin North Am. 2017; 97(6):1339-1379
Rios V. Prevalencia y factores asociados a mortalidad por sepsis en pacientes de cuidados intensivos en el hospital José Carrasco Arteaga [Tesis]. Cuenca: Universidad de Cuenca; 2018
Mosella S, Ibáñez C, Chávez M, Ugarte S. Comparación de los modelos pronósticos APACHE II y Score Salvador en sepsis abdominal. Rev Chil Med Intensiva. 2008;23(1):7-11.
Arias J, Balibrea J. Utilización de índices de gravedad en la sepsis. Cir Esp. 2001; 70(1):314-323
Ferrer R, Artigas A. Physiologic parameters as biomarkers: what can we learn from physiologic variables and variation? Crit Care Clin. 2011;27(2):229-240.
Churpek M, Zadravecz F, Winslow C, Howell M, Edelson D. Incidence and prognostic value of the systemic inflammatory response syndrome and organ dysfunctions in 60 ward patients. Am J Respir Crit Care Med. 2015;192(8):958-964
Levi M, Toh C, Thachil J, Watson H. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009; 145(1):24-33
Jılma B. Regulation of adhesion molecules during human endotoxemia. Am J Respir Crit Care Med. 1999; 159(3):857-863
Vélez J, Vélez P, Jara A, Bucheli R. ¿Es el volumen medio plaquetario un predictor de mortalidad en la sepsis? Rev. Fac Cien Med (Quito). 2015;42(1):84-90.
Zahorec R. Ratio of neutrophil to lymphocyte counts- rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102(1):5-14
Liu H, Liu G, Tian Z. Changes in blood lymphocytes in sepsis patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014;26(3):148-152
Benites-Zapata VA. Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure. Am J Cardiol. 2015; 115(1):57-61
De Jager CP. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14(2):192-206
Deutschman C, Tracey K. Sepsis: current dogma and new perspectives. Immunity. 2014;40(4):463-475
Iskander K, Osuchowski M, Stearn K, Kusosawa S, Stephen D, Vaentine C, et al. Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiol Rev. 2013;93(3):1247-1288.
Salciccioli JD. The association between the neutrophil-tolymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care. 2015;19(1):13-20
Gómez B, Sánchez L, Pérez B, Díaz G, Rodríguez W. Choque séptico. Lo que sabíamos y lo que debemos saber. Med Int Méx. 2017;33(3):381-391
Rhodes A, Evans L, Alhazzani W, Levy M, Antonelli M, Ferrer R et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017; 43(3):304-377
ProCESS investigators, Yeally D, Kellum J, Huango D, Barnato A, Weissfeld L, et a. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014; 370(18):1683-1693.
Palomba H, Correa T, Silva E, Pardini A, Assuncao M. Comparative analysis of survival between elderly and non-elderly severe sepsis and septic shock resuscitated patients. Einstein (Sao Paulo). 2015;13(3):357-363
Eamon P, Udy A, Bailey M. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290-300
Wang Y, Wang D, Fu J, Liu Y. Predictive value of SOFA, qSOFA score and traditional evaluation index on sepsis prognosis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017; 29(8):700-704
Marín D, Soto A. Comparación de sistemas de puntaje pronóstico en la predicción de mortalidad y complicaciones en la sepsis. Rev Perú Med Exp Salud Pública. 2016;33(1):51-57
Azkárate I, Cabarcos E, Choperena M, Pascal M, Salas E. Registro observacional y prospectivo de sepsis grave/shock séptico en un hospital terciario de la provincia de Guipúzcoa. Med Intensiva. 2012;36(4):250-56
Roca B. Sepsis y síndromes relacionados. Rev Med Univ Navarra. 2008;4(1):3-14
Martínez D, Beltrán A, Beloqui B, Huerta A. El índice neutrófilo/linfocito como marcador de disfunción sistémica endotelial en sujetos asintomáticos. Nefrología. 2016;36(4):397-403
Gálvez A, Mancilla N, Santos D, Carrillo R. Indice neutrófilos-linfocitos como predictor de gravedad y mortalidad en pacientes con sepsis abdominal. Med Int Méx. 2016;32(1):41-4
Azab B, Camacho M, Taioli E. Average values and racial differences of neutrophil lymphocyte ratio among a nationally representative sample of United States subjects. PLoS One. 2014;9(11):23-31
Lagunas-Alvarado M, Mijangos-Huesca FJ, Terán Gonzalez JO, Lagunas-Alvarado MG, Martinez-Zavala N, Franco Reyes I, et al. Indice de inmunidad-inflamación sistémica en sepsis. Med Int Méx. 2017;33(3):303-309
