Diagnostic and prognostic values of immunocyte ratios in patients with sepsis in the intensive care unit

Abstract

Introduction: The aim of this study was to evaluate the diagnostic and prognostic values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), monocyte-to-lymphocyte ratio (MLR), neutrophils-to-lymphocytes and platelets ratio (N/LPR), mean platelet volume-to-platelet count ratio (MPV/PC), red blood cell distribution width-to-platelet count ratio (RDW/PC), and platelet volume distribution width-to-platelet count ratio (PDW/PC) in patients with sepsis.

Methodology: A total of 203 patients with sepsis admitted to an emergent intensive care unit (EICU) were enrolled in this retrospective study. Basic data, inflammatory factors, NLR, PLR, PNR, MLR, N/LPR, MPV/PC, RDW/PC, PDW/PC were compared between survival and non-survival groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic values. The univariate and multivariate regression analyses were used for constructing a prognostic model for sepsis.

Results: There were significant differences in acute physiology and chronic health evaluation (APACHEII) score, mechanical ventilation, use of vasopressors, acute kidney injury (AKI), continuous renal replacement therapy (CRRT), long-term antiplatelet drug use, lymphocyte, monocyte, hemoglobin, procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP)*PCT, and N/LPR. APACHE II had the highest diagnostic value [Area Under Curve (AUC) = 0.999], followed by CRP*PCT (AUC = 0.718). The prognoses were different between patients stratified according to CRP, IL-6, lactic acid (Lac), PNR, PLR, PDW/PC, and APACHEII. Lac, CRP*PCT, PDW/PC, MPV/PC and APACHE II were independent prognostic factors of sepsis.

Conclusions: Both N/LPR and CRP*PCT had high values to predict mortality in sepsis patients. CRP*PCT, PDW/PC and MPV/PC were independent factors to predict the prognosis of sepsis.

Keywords: ICU; diagnosis; immunocyte; prognosis; sepsis.