Gökay GÜNGÖR, Zuhal KARAKURT, Mustafa AY, Rabia SARI, Fulya ÇİYİLTEPE, Özlem YAZICIOĞLU MOÇİN, Feyza KARGIN, Cüneyt SALTÜRK, Nalan ADIGÜZEL, Muhammed Emin ÇELİK, Ülgen YALAZ TEKAN

Neutrophil to lymphocyte ratio as a predictor of treatment response and mortality in septic shock patients in the intensive care unit

Background/aim: While C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis,it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsispatients in the intensive care unit (ICU). Materials and methods: In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shockon the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic healthevaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data,antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve(AUC) were calculated for the inflammatory markers and ICU severity scores for mortality.Results: Of the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock,330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR andCRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patientswhen compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality oddsratio was 6.96 (CI: 1.4–34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78,respectively) showed a similar increasing trend for mortality.Conclusion: The NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLRis >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.

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