The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study
Introduction The neutrophil-to-lymphocyte ratio (NLR) is a biological marker that has been shown to be associated with outcomes in patients with a number of different malignancies. The objective of this study was to assess the relationship between NLR and mortality in a population of adult critical...
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| Format: | Article |
| Language: | English |
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BioMed Central
2015
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| Online Access: | http://hdl.handle.net/1721.1/97569 |
| _version_ | 1826204623338209280 |
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| author | Salciccioli, Justin D Marshall, Dominic C Pimentel, Marco A Santos, Mauro D Pollard, Tom Shalhoub, Joseph Celi, Leo Anthony G. |
| author2 | Institute for Medical Engineering and Science |
| author_facet | Institute for Medical Engineering and Science Salciccioli, Justin D Marshall, Dominic C Pimentel, Marco A Santos, Mauro D Pollard, Tom Shalhoub, Joseph Celi, Leo Anthony G. |
| author_sort | Salciccioli, Justin D |
| collection | MIT |
| description | Introduction
The neutrophil-to-lymphocyte ratio (NLR) is a biological marker that has been shown to be associated with outcomes in patients with a number of different malignancies. The objective of this study was to assess the relationship between NLR and mortality in a population of adult critically ill patients.
Methods
We performed an observational cohort study of unselected intensive care unit (ICU) patients based on records in a large clinical database. We computed individual patient NLR and categorized patients by quartile of this ratio. The association of NLR quartiles and 28-day mortality was assessed using multivariable logistic regression. Secondary outcomes included mortality in the ICU, in-hospital mortality and 1-year mortality. An a priori subgroup analysis of patients with versus without sepsis was performed to assess any differences in the relationship between the NLR and outcomes in these cohorts.
Results
A total of 5,056 patients were included. Their 28-day mortality rate was 19%. The median age of the cohort was 65 years, and 47% were female. The median NLR for the entire cohort was 8.9 (interquartile range, 4.99 to 16.21). Following multivariable adjustments, there was a stepwise increase in mortality with increasing quartiles of NLR (first quartile: reference category; second quartile odds ratio (OR) = 1.32; 95% confidence interval (CI), 1.03 to 1.71; third quartile OR = 1.43; 95% CI, 1.12 to 1.83; 4th quartile OR = 1.71; 95% CI, 1.35 to 2.16). A similar stepwise relationship was identified in the subgroup of patients who presented without sepsis. The NLR was not associated with 28-day mortality in patients with sepsis. Increasing quartile of NLR was statistically significantly associated with secondary outcome.
Conclusion
The NLR is associated with outcomes in unselected critically ill patients. In patients with sepsis, there was no statistically significant relationship between NLR and mortality. Further investigation is required to increase understanding of the pathophysiology of this relationship and to validate these findings with data collected prospectively. |
| first_indexed | 2024-09-23T12:58:23Z |
| format | Article |
| id | mit-1721.1/97569 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T12:58:23Z |
| publishDate | 2015 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | mit-1721.1/975692022-09-28T11:14:21Z The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study Salciccioli, Justin D Marshall, Dominic C Pimentel, Marco A Santos, Mauro D Pollard, Tom Shalhoub, Joseph Celi, Leo Anthony G. Institute for Medical Engineering and Science Celi, Leo Anthony G. Introduction The neutrophil-to-lymphocyte ratio (NLR) is a biological marker that has been shown to be associated with outcomes in patients with a number of different malignancies. The objective of this study was to assess the relationship between NLR and mortality in a population of adult critically ill patients. Methods We performed an observational cohort study of unselected intensive care unit (ICU) patients based on records in a large clinical database. We computed individual patient NLR and categorized patients by quartile of this ratio. The association of NLR quartiles and 28-day mortality was assessed using multivariable logistic regression. Secondary outcomes included mortality in the ICU, in-hospital mortality and 1-year mortality. An a priori subgroup analysis of patients with versus without sepsis was performed to assess any differences in the relationship between the NLR and outcomes in these cohorts. Results A total of 5,056 patients were included. Their 28-day mortality rate was 19%. The median age of the cohort was 65 years, and 47% were female. The median NLR for the entire cohort was 8.9 (interquartile range, 4.99 to 16.21). Following multivariable adjustments, there was a stepwise increase in mortality with increasing quartiles of NLR (first quartile: reference category; second quartile odds ratio (OR) = 1.32; 95% confidence interval (CI), 1.03 to 1.71; third quartile OR = 1.43; 95% CI, 1.12 to 1.83; 4th quartile OR = 1.71; 95% CI, 1.35 to 2.16). A similar stepwise relationship was identified in the subgroup of patients who presented without sepsis. The NLR was not associated with 28-day mortality in patients with sepsis. Increasing quartile of NLR was statistically significantly associated with secondary outcome. Conclusion The NLR is associated with outcomes in unselected critically ill patients. In patients with sepsis, there was no statistically significant relationship between NLR and mortality. Further investigation is required to increase understanding of the pathophysiology of this relationship and to validate these findings with data collected prospectively. National Institutes of Health (U.S.) (Grant R01 EB017205-01A1) 2015-06-29T18:31:44Z 2015-06-29T18:31:44Z 2015-01 2014-09 2015-06-29T08:40:09Z Article http://purl.org/eprint/type/JournalArticle 1364-8535 1875-7081 http://hdl.handle.net/1721.1/97569 Salciccioli, Justin D, Dominic C Marshall, Marco Pimentel, Mauro D Santos, Tom Pollard, Leo Celi, and Joseph Shalhoub. “The Association Between the Neutrophil-to-Lymphocyte Ratio and Mortality in Critical Illness: An Observational Cohort Study.” Crit Care 19, no. 1 (2015): 13. en http://dx.doi.org/10.1186/s13054-014-0731-6 Critical Care Salciccioli et al.; licensee BioMed Central. application/pdf BioMed Central |
| spellingShingle | Salciccioli, Justin D Marshall, Dominic C Pimentel, Marco A Santos, Mauro D Pollard, Tom Shalhoub, Joseph Celi, Leo Anthony G. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study |
| title | The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study |
| title_full | The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study |
| title_fullStr | The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study |
| title_full_unstemmed | The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study |
| title_short | The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study |
| title_sort | association between the neutrophil to lymphocyte ratio and mortality in critical illness an observational cohort study |
| url | http://hdl.handle.net/1721.1/97569 |
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