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Article

The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay

by
Ioana Denisa Botoș
1,†,
Carmen Pantiș
1,†,
Constantin Bodolea
2,3,*,
Andrada Nemes
2,3,
Dana Crișan
3,4,
Lucreția Avram
3,4,
Marcel Ovidiu Negrău
1,
Ioana Elisabeta Hirișcău
3,
Rareș Crăciun
3,5 and
Cosmin Ioan Puia
1,3,6
1
Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
2
Intensive Care Unit, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
3
Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
4
Department of Internal Medicine, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
5
Gastroenterology Clinic, “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
6
Department of Surgery, “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Medicina 2023, 59(1), 32; https://doi.org/10.3390/medicina59010032
Submission received: 23 November 2022 / Revised: 12 December 2022 / Accepted: 21 December 2022 / Published: 23 December 2022
(This article belongs to the Special Issue New Strategies for the Diagnosis and Treatment of Sepsis and Septic Shock)
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Abstract

Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles of the neutrophil-to-lymphocyte (NLR), derived-NRL (d-NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-C-reactive protein (LCR) ratios in predicting the progression to septic shock and death. Materials and Methods: A retrospective analysis of a consecutive series of ninety COVID-19 patients with prolonged hospitalization (exceeding 15 days) admitted to the ICU was conducted. The prevalence of culture-proven HAIs throughout their hospital stays was documented. NLR, dNLR, PLR, and LCR were recorded on admission, day 7, and day 14 to assess their discriminative prowess for detecting further progression to septic shock or death. Results: The prevalence of HAIs was 76.6%, 50% of patients met the criteria for septic shock, and 50% died. The median time to the first positive culture was 13.5 days and 20.5 days for developing septic shock. Mechanical ventilation was a key contributing factor to HAI, septic shock, and mortality. On admission and day 7 NLR, dNLR, PLR, and LCR values had no prognostic relevance for events occurring late during hospitalization. However, day-14 NLR, dNLR, and PLR were independent predictors for progression to septic shock and mortality and have shown good discriminative capabilities. The AUCs for septic shock were 0.762, 0.764, and 0.716, while the values for predicting in-hospital death were 0.782, 0.778, and 0.758, respectively. Conclusions: NLR, dNLR, and PLR are quick, easy-to-use, cheap, effective biomarkers for the detection of a more severe disease course, of the late development of HAIs, and of the risk of death in critically ill patients requiring a prolonged ICU stay.
Keywords: sepsis; septic shock; intensive care; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; hospital-acquired infections sepsis; septic shock; intensive care; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; hospital-acquired infections

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MDPI and ACS Style

Botoș, I.D.; Pantiș, C.; Bodolea, C.; Nemes, A.; Crișan, D.; Avram, L.; Negrău, M.O.; Hirișcău, I.E.; Crăciun, R.; Puia, C.I. The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay. Medicina 2023, 59, 32. https://doi.org/10.3390/medicina59010032

AMA Style

Botoș ID, Pantiș C, Bodolea C, Nemes A, Crișan D, Avram L, Negrău MO, Hirișcău IE, Crăciun R, Puia CI. The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay. Medicina. 2023; 59(1):32. https://doi.org/10.3390/medicina59010032

Chicago/Turabian Style

Botoș, Ioana Denisa, Carmen Pantiș, Constantin Bodolea, Andrada Nemes, Dana Crișan, Lucreția Avram, Marcel Ovidiu Negrău, Ioana Elisabeta Hirișcău, Rareș Crăciun, and Cosmin Ioan Puia. 2023. "The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay" Medicina 59, no. 1: 32. https://doi.org/10.3390/medicina59010032

APA Style

Botoș, I. D., Pantiș, C., Bodolea, C., Nemes, A., Crișan, D., Avram, L., Negrău, M. O., Hirișcău, I. E., Crăciun, R., & Puia, C. I. (2023). The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay. Medicina, 59(1), 32. https://doi.org/10.3390/medicina59010032

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