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[Dynamic monitoring of the neutrophil/lymphocyte ratio could predict the prognosis of patients with bloodstream infection].
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015 Jun; 27(6):471-6.ZW

Abstract

OBJECTIVE

To explore the value of dynamic monitoring of the neutrophils/lymphocyte ratio (NLR) in peripheral blood for the prognosis of patients with bloodstream infection (BSI).

METHODS

A retrospective study was conducted. 205 patients who were ≥18 years old, their length of hospital stay>24 hours, and they were treated in the China-Japanese Friendship Hospital from January 2013 to October 2014 were enrolled. According to the 28-day survival, the patients were divided into survival group (n=160) and death group (n=45). The white blood cell (WBC), neutrophils count (NEU), neutrophils ratio (Neut%), lymphocyte count (LYM), lymphocyte ratio (Lym%), and NLR in peripheral blood were recorded at 1, 3, 7 days after admission. Receiver-operating characteristic curve (ROC) was plotted for evaluating the value of these factors on the 28-day prognosis, and logistic regression analysis was used to evaluate the risk factors for predicting the outcome.

RESULTS

(1) On the 1st day, WBC, NEU, Neut%, NLR, and procalcitonin (PCT) in the death group were significantly higher than those in the survival group [WBC (×10(9)/L): 15.28±8.23 vs. 11.58±6.55, NEU (×10(9)/L): 13.34±7.53 vs. 10.03±5.31, Neut%: 0.886±0.076 vs. 0.845±0.102, NLR: 21.20 (13.10, 28.80) vs. 12.08 (6.81, 20.47), PCT (μg/L): 3.13 (0.85, 10.12) vs. 1.34 (0.36, 5.81), P<0.05 or P<0.01], while hemoglobin (Hb), platelet count (PLT), albumin (ALB) content were significantly lower than those of the survival group [Hb (g/L): 86.09±19.83 vs. 107.89±22.82, PLT (×10(9)/L): 157.51±117.81 vs. 195.44±97.28, ALB (g/L): 24.11±6.94 vs. 31.99±6.89, P<0.05 or P<0.01]. On the 3rd day and 7th day, WBC, NEU and NLR in the death group were significantly higher than those of the survival group [WBC (×10(9)/L): 16.61±10.25 vs. 8.91±4.93, 16.05±9.46 vs. 8.79±4.45; NEU (×10(9)/L): 14.15±9.98 vs. 6.97±4.64, 14.36±9.03 vs. 6.59±4.07; NLR: 24.13 (8.49, 38.26) vs. 5.52 (3.58, 8.87), 17.74 (10.74, 32.85) vs. 4.35 (2.78, 7.27), all P<0.01 ], and the LYM and Lym% were significantly lower than those in the survival group [LYM (×10(9)/L): 0.61 (0.38, 1.04) vs. 1.05 (0.78, 1.43), 0.69 (0.35, 0.92) vs. 1.37 (0.93, 1.76); Lym%: 0.039 (0.024, 0.101) vs. 0.135 (0.094, 0.186), 0.056 (0.033, 0.082) vs. 0.170 (0.108, 0.237), all P<0.01]. (2) It was shown by ROC curve that the maximum area under the ROC curve (AUC) of WBC, NEU, Neut%, LYM, Lym%, and NLR about prognosis of BSI were observed on 7 days (0.777, 0.819, 0.905, 0.755, 0.880, 0.887). Based on Neut%>0.855 on the 7th day as a predictor of cut-off value of death in 28 days, the sensitivity was 78.8%, specificity 89.1%, respectively. When Lym%<0.088 on the 7th day as a predictor of cut-off value of death on 28 days, the sensitivity was 89.5%, and specificity was 83.9%. When NLR>10.34 on the 7th day as a predictor of cut-off value of death in 28 days, the sensitivity was 81.8%, and specificity was 91.0%. (3) Survival analysis showed that the 28-day survival rate in the patients with 7-day NLR<10.34 was significantly higher than that in those with 7-day NLR>10.34 (95.0% vs. 34.1%, χ2=82.650, P=0.000). (4) It was shown by multi-factor logistic regression analysis that the levels of 1-day Hb and 7-day NLR were the independent prognostic predictors of 28-day mortality [Hb: odds ratio (OR)=0.946, 95% confidence interval (95%CI)=0.913-0.981, P=0.003; 7-day NLR: OR=34.941, 95%CI=8.728-139.884, P=0.000].

CONCLUSIONS

The trend of changes in NEU, LYM and NLR as shown by repeated routine blood examinations contributes to prediction of the outcome of patients with BSI. The levels of 1-day Hb and 7-day NLR are the independent prognostic predictors for 28-day mortality.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Yang M
Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing 100029, China. Corresponding author: Lin Jiangtao, Email: jiangtao_1@263.net.
Li L
No affiliation info available
Su N
No affiliation info available
Lin J
No affiliation info available
Wang J
No affiliation info available

MeSH

BacteremiaCalcitoninCalcitonin Gene-Related PeptideHumansLength of StayLeukocyte CountLymphocyte CountLymphocytesNeutrophilsPlatelet CountPrognosisProtein PrecursorsROC CurveRetrospective StudiesRisk FactorsSurvival Rate

Pub Type(s)

Journal Article

Language

chi

PubMed ID

26049186

Clinical Trial Links

Predictors of Neonatal Necrotizing Enterocolitis

Citation

Yang, Meng, et al. "[Dynamic Monitoring of the Neutrophil/lymphocyte Ratio Could Predict the Prognosis of Patients With Bloodstream Infection]." Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, vol. 27, no. 6, 2015, pp. 471-6.
Yang M, Li L, Su N, et al. [Dynamic monitoring of the neutrophil/lymphocyte ratio could predict the prognosis of patients with bloodstream infection]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015;27(6):471-6.
Yang, M., Li, L., Su, N., Lin, J., & Wang, J. (2015). [Dynamic monitoring of the neutrophil/lymphocyte ratio could predict the prognosis of patients with bloodstream infection]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 27(6), 471-6. https://doi.org/10.3760/cma.j.issn.2095-4352.2015.06.011
Yang M, et al. [Dynamic Monitoring of the Neutrophil/lymphocyte Ratio Could Predict the Prognosis of Patients With Bloodstream Infection]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015;27(6):471-6. PubMed PMID: 26049186.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Dynamic monitoring of the neutrophil/lymphocyte ratio could predict the prognosis of patients with bloodstream infection]. AU - Yang,Meng, AU - Li,Lijuan, AU - Su,Nan, AU - Lin,Jiangtao, AU - Wang,Jing, PY - 2015/6/8/entrez PY - 2015/6/8/pubmed PY - 2016/6/22/medline SP - 471 EP - 6 JF - Zhonghua wei zhong bing ji jiu yi xue JO - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue VL - 27 IS - 6 N2 - OBJECTIVE: To explore the value of dynamic monitoring of the neutrophils/lymphocyte ratio (NLR) in peripheral blood for the prognosis of patients with bloodstream infection (BSI). METHODS: A retrospective study was conducted. 205 patients who were ≥18 years old, their length of hospital stay>24 hours, and they were treated in the China-Japanese Friendship Hospital from January 2013 to October 2014 were enrolled. According to the 28-day survival, the patients were divided into survival group (n=160) and death group (n=45). The white blood cell (WBC), neutrophils count (NEU), neutrophils ratio (Neut%), lymphocyte count (LYM), lymphocyte ratio (Lym%), and NLR in peripheral blood were recorded at 1, 3, 7 days after admission. Receiver-operating characteristic curve (ROC) was plotted for evaluating the value of these factors on the 28-day prognosis, and logistic regression analysis was used to evaluate the risk factors for predicting the outcome. RESULTS: (1) On the 1st day, WBC, NEU, Neut%, NLR, and procalcitonin (PCT) in the death group were significantly higher than those in the survival group [WBC (×10(9)/L): 15.28±8.23 vs. 11.58±6.55, NEU (×10(9)/L): 13.34±7.53 vs. 10.03±5.31, Neut%: 0.886±0.076 vs. 0.845±0.102, NLR: 21.20 (13.10, 28.80) vs. 12.08 (6.81, 20.47), PCT (μg/L): 3.13 (0.85, 10.12) vs. 1.34 (0.36, 5.81), P<0.05 or P<0.01], while hemoglobin (Hb), platelet count (PLT), albumin (ALB) content were significantly lower than those of the survival group [Hb (g/L): 86.09±19.83 vs. 107.89±22.82, PLT (×10(9)/L): 157.51±117.81 vs. 195.44±97.28, ALB (g/L): 24.11±6.94 vs. 31.99±6.89, P<0.05 or P<0.01]. On the 3rd day and 7th day, WBC, NEU and NLR in the death group were significantly higher than those of the survival group [WBC (×10(9)/L): 16.61±10.25 vs. 8.91±4.93, 16.05±9.46 vs. 8.79±4.45; NEU (×10(9)/L): 14.15±9.98 vs. 6.97±4.64, 14.36±9.03 vs. 6.59±4.07; NLR: 24.13 (8.49, 38.26) vs. 5.52 (3.58, 8.87), 17.74 (10.74, 32.85) vs. 4.35 (2.78, 7.27), all P<0.01 ], and the LYM and Lym% were significantly lower than those in the survival group [LYM (×10(9)/L): 0.61 (0.38, 1.04) vs. 1.05 (0.78, 1.43), 0.69 (0.35, 0.92) vs. 1.37 (0.93, 1.76); Lym%: 0.039 (0.024, 0.101) vs. 0.135 (0.094, 0.186), 0.056 (0.033, 0.082) vs. 0.170 (0.108, 0.237), all P<0.01]. (2) It was shown by ROC curve that the maximum area under the ROC curve (AUC) of WBC, NEU, Neut%, LYM, Lym%, and NLR about prognosis of BSI were observed on 7 days (0.777, 0.819, 0.905, 0.755, 0.880, 0.887). Based on Neut%>0.855 on the 7th day as a predictor of cut-off value of death in 28 days, the sensitivity was 78.8%, specificity 89.1%, respectively. When Lym%<0.088 on the 7th day as a predictor of cut-off value of death on 28 days, the sensitivity was 89.5%, and specificity was 83.9%. When NLR>10.34 on the 7th day as a predictor of cut-off value of death in 28 days, the sensitivity was 81.8%, and specificity was 91.0%. (3) Survival analysis showed that the 28-day survival rate in the patients with 7-day NLR<10.34 was significantly higher than that in those with 7-day NLR>10.34 (95.0% vs. 34.1%, χ2=82.650, P=0.000). (4) It was shown by multi-factor logistic regression analysis that the levels of 1-day Hb and 7-day NLR were the independent prognostic predictors of 28-day mortality [Hb: odds ratio (OR)=0.946, 95% confidence interval (95%CI)=0.913-0.981, P=0.003; 7-day NLR: OR=34.941, 95%CI=8.728-139.884, P=0.000]. CONCLUSIONS: The trend of changes in NEU, LYM and NLR as shown by repeated routine blood examinations contributes to prediction of the outcome of patients with BSI. The levels of 1-day Hb and 7-day NLR are the independent prognostic predictors for 28-day mortality. SN - 2095-4352 UR - https://www.unboundmedicine.com/medline/citation/26049186/[Dynamic_monitoring_of_the_neutrophil/lymphocyte_ratio_could_predict_the_prognosis_of_patients_with_bloodstream_infection]_ DB - PRIME DP - Unbound Medicine ER -