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J Korean Soc Emerg Med > Volume 34(3); 2023 > 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
Youngbin Jang1 , Sung Phil Chung1 , Je Sung You1 , Tae Young Kong1 , Dong Ryul Ko1,2
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.
This study verifies the practicality of the delta neutrophil index to lymphocyte ratio for the prognostic evaluation of sepsis patients.
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.
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.
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
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