Usefulness of the delta neutrophil index to lymphocyte ratio to predict prognosis in sepsis patients in the emergency department

Jang, Youngbin; Chung, Sung Phil; You, Je Sung; Kong, Tae Young; Ko, Dong Ryul

J Korean Soc Emerg Med > Volume 34(3); 2023 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2023;34(3): 230-240.

Usefulness of the delta neutrophil index to lymphocyte ratio to predict prognosis in sepsis patients in the emergency department

, Dong Ryul Ko^1,2

¹Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
²Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon, Korea

Correspondence

Dong Ryul Ko ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: kkdry@yuhs.ac,

Received: June 27, 2022; Revised: October 19, 2022 Accepted: October 19, 2022. Published online: June 30, 2023.

ABSTRACT

Objective:
This study verifies the practicality of the delta neutrophil index to lymphocyte ratio for the prognostic evaluation of sepsis patients.
Method:
Records of 2,233 patients diagnosed with sepsis were reviewed; 1,042 patients were included in the final analysis. Receiver operating characteristic (ROC) curve studies were used to calculate the area under the curve (AUC) to determine the neutrophil-to-lymphocyte ratio (NLR) and the delta neutrophil-to-lymphocyte ratio (Delta-NLR). To adjust for skewed distributions, the NLR and Delta-NLR were analyzed after natural logarithm transformations. Multivariate logistic regression was applied to determine potential predictors for mortality.
Results:
To predict 30-day mortality, AUCs were performed using the values of days 0, 1, and 2 (0.604, P<0.0001; 0.648, P<0.0001; and 0.684, P<0.0001, respectively). The NLR results were 0.504 (P=0.8624), 0.553 (P=0.0191), and 0.598 (P<0.0001), respectively. The AUC increased significantly when the Delta-NLR at day 0 was combined with age, hemoglobin levels, and lactate levels. Further subgroup analysis was performed by dividing patients into an upper respiratory infection (URI) group, a gastrointestinal tract infection (GI) (including hepatobiliary infection) group, and a urinary tract infection (UTI) group. The predictive ability of the GI group was determined to be much higher than the other two groups.
Conclusion:
Increase in the Delta-NLR of sepsis patients was found to be an independent predictor of mortality within 30 days.

Key words: Sepsis; Mortality; prognose; Biomarkers; Neutrophils; Lymphocytes