Prognostic value of neutrophil-to-lymphocyte ratio in patients with sepsis at the emergency department

• Wiem Demni

  Emergency department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis Elmanar,

• Emna Ben Mhamed

  Emergency department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis Elmanar

• Yessmine Walha

  Emergency department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis Elmanar

• Dhekra Hamdi

  Emergency department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis Elmanar

• Fadoua Lachter

  Emergency department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis Elmanar

• Wided Bahria

  Emergency department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis Elmanar

• Nourelhouda Nouira

  Emergency department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis Elmanar

Introduction:

Sepsis represents a diagnostic and therapeutic emergency, responsible for significant morbidity and mortality. The prognostic value of neutrophil-to-lymphocyte ratio has been studied in different pathologies, particularly in septic patients. The aim of our study was to evaluate the prognostic value of neutrophil-to-lymphocyte ratio in septic patients admitted to the emergency department.

Methods:

This was a prospective, observational, descriptive, and analytical study. We included all patients with sepsis admitted to the emergency department. We collected epidemiological, clinical, biological, therapeutic, and evolutionary data and calculated neutrophil-to-lymphocyte ratio at admission. To determine the prognostic value of neutrophil-to-lymphocyte ratio, we established and analyzed the ROC curve.

Results:

We included 106 patients. The average age was 65 ± 15 years. The sex ratio (F/M) was 1.4. The main medical histories were: diabetes (52.8%), hypertension (46.2%), coronaropathy (16%), and chronic renal failure (12.3%). The main reasons for consultation were general deterioration (84.9%), digestive signs (43.4%), and respiratory signs (43.4%). The most frequently selected infectious entry points were respiratory (37.7%), urinary (30.2%), and cutaneous (20.8%). Septic shock was diagnosed on admission in 26 patients (24.5%). The median neutrophil-to-lymphocyte ratio at admission was 9 [5-23]. On 72 hours of hospitalization, the intra-hospital mortality rate was 25.5%. In univariate analysis, neutrophil-to-lymphocyte ratio appeared as a predictive factor for early intra-hospital mortality (p=0,003, OR= 2.96, CI95%=[3.23-14.97]). The area under the ROC curve of neutrophil-to-lymphocyte ratio according to mortality was 0.75 (p<0.001, CI95%=0.66-0.85). A neutrophil-to-lymphocyte ratio cut-off of 6 was predictive of early mortality (p=0.003, Se=92%, Sp=68%, PPV=42%, NPV=97%) and evolution in septic shock (p=0.04).

Conclusion

Neutrophil-to-lymphocyte ratio has prognostic value in septic patients, which allows to identify high-risk patients with unfavorable evolution.

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