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J Korean Soc Emerg Med > Volume 33(6); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(6): 565-572.
The association between the neutrophil-to-lymphocyte ratio and bacteremia in elderly patients admitted to the emergency department
Ji Sun Yu1 , Hwan Song1 , Chun Song Youn1 , Sang Hoon Oh1 , Jeeyong Lim1 , Soo Hyun Kim2 , Hyo Jin Bang1 , Hyo Joon Kim1
1Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Emergency Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence  Hyo Joon Kim ,Tel: 02-2258-2002, Fax: 02-2258-1997, Email: khjoon0110@gmail.com,
Received: October 14, 2021; Revised: November 14, 2021   Accepted: November 15, 2021.  Published online: December 31, 2022.
Bacteremia is a common cause of increased morbidity and mortality in elderly patients, but early diagnosis and identification are complex. The neutrophil-to-lymphocyte count ratio (NLR) is suggested as a useful indicator for diagnosing bloodstream infections. This study evaluated whether the NLR at admission is associated with bloodstream infections in older patients admitted to the emergency department.
A retrospective, multicenter analysis was performed on patients admitted to the emergency department from November 2016 to February 2017. We included patients aged 65 years and older who visited the emergency department with medical problems. Baseline NLR values were measured upon admission to the emergency department. The primary outcome was a positive blood culture.
A total of 1,815 patients were included in this study. The median age was 77.25±7.38 years, and bacteremia was identified in 290 older patients (15.9%). The NLR was significantly higher in the bacteremia group (15.95±22.03) than in the non-bacteremia group (8.76±8.74, P<0.001). In the multivariate logistic regression analysis, the NLR was associated with bacteremia after adjusting for confounding factors as continuous variables (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.009-1.057) and categorical variables (NLR ≥10; OR, 2.018; 95% CI, 1.246-3.268). The area under the curve of the NLR was determined to be 0.667 (95% CI, 0.639-0.694).
These results indicate that the NLR at admission to the emergency department is associated with bloodstream infections. Early suspicion of bacteremia, by determining the initial NLR value, will help treat bacteremia in elderly patients.
Key words: Aged; Bacteremia; Neutrophils; Lymphocytes
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