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. 2025 Jul 31:18:4157-4167.
doi: 10.2147/IJGM.S537039. eCollection 2025.

Correlation of Neutrophil-Lymphocyte Ratio and Critical Illness in Adults on Vancomycin: A Cross-Sectional Study

Mohammad A Alfhili  1 , Sahar A Alazmi  1 , Jawaher Mohammad Alsughayyir  1
Affiliations

Correlation of Neutrophil-Lymphocyte Ratio and Critical Illness in Adults on Vancomycin: A Cross-Sectional Study

Mohammad A Alfhili et al. Int J Gen Med. .

Abstract

Background: Early risk-stratification in patients receiving vancomycin (VAN) is crucial but reliable markers are scarce. Herein, the correlates and determinants of neutrophil-lymphocyte ratio (NLR), an emerging inflammatory marker, with ICU admission in VAN-treated adults were investigated.

Methods: Demographic and clinical data for 295 adults treated with VAN at King Khalid University Hospital from January 2024 to February 2025 were retrospectively analyzed using Mann-Whitney U and Chi-square tests, Spearman rank correlation, regression analysis, effect size measures, and calculation of areas under the receiver operating characteristic curve (AUC).

Results: NLR was significantly elevated in ICU compared to non-ICU patients (p <0.0001) and the proportion of ICU patients with elevated NLR was significantly higher than those with normal NLR (X 2 = 33.69, p <0.0001) irrespective of age or gender. In particular, ICU requirement was 2.49 and 2.54 times more prevalent in males and females with elevated NLR, respectively (p = 0.0002). Also, ICU admission was 4.25 and 4.40 times more likely when NLR was elevated in males and females, respectively (p = 0.0001). Notably, ICU admission was independently associated with a 9.65-unit increase in NLR (p = 0.0005) of which age, body mass index, and conjugated bilirubin were identified as independent predictors. Moreover, NLR showed good diagnostic ability for ICU requirement with AUC ranging from 0.71 to 0.78 (p <0.0001).

Conclusion: NLR is easily accessible, cost-effective, and demonstrates promising potential to complement existing markers for identifying high-risk patients and optimizing early intervention in critically ill adults receiving VAN therapy.

Keywords: ICU; NLR; inflammation; sepsis; vancomycin.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Elevated NLR in ICU patients. NLR values for (A) all subjects, (B) males, (C) females, (D) young, (E) adults, and (F) elderlies. Data are shown as medians + IQR. ****(p <0.0001).
Figure 2
Figure 2
Diagnostic accuracy of NLR for ICU admission. ROC curves for (A) all subjects, (B) males, (C) females, (D) young, (E) adults, and (F) elderlies.
See this image and copyright information in PMC

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