Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar;20(2):553-562.
doi: 10.1007/s11739-024-03683-8. Epub 2024 Jun 25.

Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department

Gioacchino Galardo  1   2 , Luca Crisanti  3 , Andrea Gentile  1 , Marco Cornacchia  1 , Francesca Iatomasi  1 , Iacopo Egiddi  1 , Emanuele Puscio  1 , Danilo Menichelli  1 , Francesco Pugliese  4 , Daniele Pastori  5   6 ; and the Research on Medical patients Admitted to the Emergency Department (ROMA-ED) investigators
Affiliations

Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department

Gioacchino Galardo et al. Intern Emerg Med. 2025 Mar.

Abstract

Early identification of patients with a poorer prognosis in the Emergency Department (ED) is crucial for prompt treatment and resource allocation. We investigated the relationship between the Neutrophil to Lymphocyte Ratio (NLR) and 30-day mortality in elderly acute medical patients. Prospective single-center cohort study including consecutive patients admitted to the ED. Inclusion criteria were age > 65 years and medical condition as the cause of ED access. Exclusion criteria were patients admitted for traumatic injuries or non-traumatic surgical diseases. ROC analysis was used to set the best cut-off of the NLR for mortality. 953 patients were included and 142 (14.9%) died during follow-up. ROC analysis showed a good predictive value of the NLR with an AUC 0.70, 95%CI 0.67-0.73 (p < 0.001) and identified a NLR > 8 as the best cut-off. Patients with NLR > 8 had a more serious triage code (72.6% had a triage code ≤ 2) and an increased heart rate and body temperature. They more often presented with dyspnea, abdominal pain, falls and vomiting. They also were characterized by an increase in urea, creatinine, white blood cells, neutrophils, fibrinogen, D-dimer, glycemia, CRP, LDH and transaminases and by a decrease in eGFR, of lymphocytes and monocytes. Multivariable logistic regression analysis demonstrated that the NLR remained associated with mortality after adjustment for confounders (Odds ratio 2.563, 95%CI 1.595-4.118, p < 0.001). Patients with NLR > 8 showed a higher mortality rate. NLR is an easy and inexpensive tool that may be used for risk stratification in the ED. The results of this study need to be validated in larger external cohorts.

Keywords: Emergency department (ED); Mortality; Neutrophil-to-lymphocyte ratio (NLR).

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors designed the study, gathered and analyzed the data, vouched for the data and analysis, wrote the paper, and decided to publish. Drs. Pastori, Galardo, and Pugliese had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The manuscript and its contents have not been published previously and are not being considered for publication elsewhere in whole or in part in any language, including publicly accessible websites or e-print servers. All other authors declare that they have no conflict of interest with this study. Ethical approval: The study was carried out according to the principles of the Declaration of Helsinki and approved by the Sapienza University of Rome Ethics committee (Prot. 0405/2022). Informed consent: Written informed consent was obtained from the participants.

Figures

Fig. 1
Fig. 1
ROC analysis for all-cause mortality. NLR Neutrophil to lymphocyte ratio
See this image and copyright information in PMC

References

    1. Aminzadeh F, Dalziel WB (2002) Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 39:238–247. 10.1067/mem.2002.121523 - PubMed
    1. Karamercan MA, Dündar DZ, Slagman A, Ergin M, Janssens KAC, Fabbri A, Bjornsen LP, Somodi S, Adam VN, Polyzogopoulou E, Demir HA, Laribi S, on behalf of the EGERS study investigators (2023) Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study. Eur J Emerg Med 30:117–124. 10.1097/MEJ.0000000000000997 - PubMed
    1. Valli G, Galati E, De Marco F, Bucci C, Fratini P, Cennamo E, Ancona C, Volpe N, Ruggieri MP (2021) In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission. Clin Exp Emerg Med 8:325–332. 10.15441/ceem.21.020 - PMC - PubMed
    1. Barba R, Martínez JM, Zapatero A, Plaza S, Losa JE, Canora J, Pérez A, De Casasola GG (2011) Mortality and complications in very old patients (90+) admitted to departments of internal medicine in Spain. Eur J Intern Med 22:49–52. 10.1016/j.ejim.2010.11.001 - PubMed
    1. Ayaz T, Sahin SB, Sahin OZ, Bilir O, Rakıcı H (2014) Factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. J Aging Res 2014:1–7. 10.1155/2014/584315 - PMC - PubMed

LinkOut - more resources