“Early - Easy way” to predict a mortality in intensive care unit

• Published in: Journal of critical care Vol. 81; p. 154758
• Main Authors: Baterdene, Batsuren, Begzjav, Tsolmon, Davaadagva, Narangarav, Buyantogtokh, Kherlenchimeg
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01-06-2024; Elsevier Limited
• Subjects: Intensive care; Low-income country; Lymphocytes; Mortality; Neutrophil – to – lymphocyte ratio; Neutrophils; Simple tool; Neutrophil – to – lymphocyte ratio; Low-income country; Mortality; Simple tool
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154758

Identifying high-risk patients early in the intensive care unit (ICU) is one of the important issues in rural hospitals. In low-income countries existing scoring systems are in lack of easy access and additional specialized equipment for laboratory is high-cost, it is important to have a simple way to predict a mortality. Neutrophil – to – lymphocyte ratio (NLR) has a well-known prognostic value and independently correlates with mortality in several specific subsets of diseases. The NLR, calculated as a simple ratio between the absolute neutrophil and lymphocyte counts measured in peripheral blood, recently it considered as part of the decision-making processes concerning the admission and the recovery of patients. This study aims to investigate neutrophil – to – lymphocyte ratio in routine blood tests to predict mortality in ICU patients and evaluate their predictive power, also compare with other inflammatory markers.
Retrospective single centered study. We analyzed data from the medical Information database of ICU of International medical center during 2014–2023 years. A total of 821 ICU patients were enrolled and divided into survival and non-survival groups based on in-hospital mortality. After identifying the NLR patients were divided into low (≤1), normal (1–3), grey zone (3–6), mild (6–9), moderate (9–18) and severe (>18) physiologic stress groups. Logistic regression analyses were performed to evaluate the association between the NLR, CRP, PCT and severity of clinical course, which was expressed by means of SOFA and APACHE II scores, between two groups. The area under the curve, net reclassification were used to assess the NLR could improve the predictive power of existing scoring systems.
The NLR is influenced by conditions including medication, chronic diseases, cancer of solid organs. A normal range of NLR is between 1 and 6, the values higher than 6 and below 0.7 in adults are pathological. In non-survival group physiological stress rates were significantly higher than in the normal, medium NLR groups. The NLR had the best predictive ability (p < 0.001) than immunochemical values. The AUC from 0.789 to 0.795, with an NRI of 16.64% Comparing to CRP, PCT values NLRs were changed in more early stages of the disease.
NLR is a cheap and easy-to-obtain marker, which is more time sensitive than CRP, PCT, that could be considered as a prognostic marker of disease severity, predictor of mortality, and guide for therapeutic strategy in resource limited setting.