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VOLUME 25 , ISSUE 7 ( July, 2021 ) > List of Articles

Original Article

Is Neutrophil–Lymphocyte Count Ratio a Better Indicator of Sepsis with Gram-positive Bacterial Infection?

Uun Sumardi, Diah R Prihardianti, Primal Sudjana

Citation Information : Sumardi U, Prihardianti DR, Sudjana P. Is Neutrophil–Lymphocyte Count Ratio a Better Indicator of Sepsis with Gram-positive Bacterial Infection?. Indian J Crit Care Med 2021; 25 (7):795-799.

DOI: 10.5005/jp-journals-10071-23892

License: CC BY-NC 4.0

Published Online: 07-07-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Sepsis is the main cause of death in infectious diseases that can be caused by gram-negative or gram-positive bacteria. Definitive therapy for sepsis is antibiotics, depending on blood culture results even though it takes time for bacterial growth. Neutrophil–lymphocyte count ratio (NLCR) is a laboratory parameter that can predict bacterial infection in sepsis patients. NLCR is time-and-cost-effective and easy-to-use in daily practice, in sepsis patients infected with gram-negative, gram-positive, and no bacterial growth based on blood culture results. Materials and methods: This was a comparative study of NLCR and the result of blood culture from sepsis patients. Subjects were obtained from the medical records of patients admitted to our hospital from January 2019 to May 2019. Patients aged over 18 years who were diagnosed with sepsis and had blood culture information were included. Patients with hematological disorder and malignancy were excluded. Sepsis data consisted of gender, age, source of infection, comorbidity, NLCR, and blood culture results. Results: Ninety-four sepsis subjects met the inclusion criteria, and fifty-one subjects (54.25%)—33 subjects (35.10%) with gram-negative bacterial infection and 18 subjects (19.15%) with gram-positive bacterial infection—were included in the analysis due to the completeness of the data. The median NLCR (IQR) was 17.8 (14.3–30.7) in gram-negative, 31.5 (26.3–95.0) in gram-positive, and 22.8 (15.67–22.75) in no bacterial growth (p = 0.001). Conclusion: NLCR can distinguish gram-negative and gram-positive bacterial infections. It also can predict the possibility of pathogenic bacteria that cause sepsis.

  1. Phua J, Ngerng W, See K, Tay C, Kiong T, Lim H, et al. Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit Care 2013;17(5):R202. DOI: 10.1186/cc12896.
  2. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet (London, England) 2020:395(10219):200–211. DOI: 10.1016/S0140-6736(19)32989-7.
  3. Parwati I. Pola Mikroba dan kepekaan terhadap berbagai antimikroba Rumah Sakit Umum Pusat DR. Hasan Sadikin Bandung. Divisi mikrobiologi klinik Instalasi Laboratori-um Klinik RSHS; 2017. p. 96–98.
  4. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580–637. DOI: 10.1097/CCM.0b013e31827e83af.
  5. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  6. Jonathan PE, Zulfariansyah A. Correlation between neutrophil-lymphocyte count ratio and procalcitonin in sepsis and septic shock. MKB 2019;51(3):165–171. DOI: 10.15395/mkb.v51n3.1642.
  7. Nurdani A, Hadi U, Arfijanto MV, Rusli M, Bramantono, Miftahussurur M. Neutrophil-lymphocyte ratio and procalcitonin levels in sepsis patients. New Armenian Med J 2019;13(1):48–54.
  8. Yana K. Faktor-faktor yang mempengaruhi rendahnya positivitas hasil kultur darah pada penderita sepsis. Rumah Sakit Dr. Hasan Sadikin Universitas Padjajaran; 2017.
  9. Yuan Q, Wang J, Peng Z, Zhou Q, Xiao X, Xie Y, et al. Neutrophil-to-lymphocyte ratio and incident end-stage renal disease in Chinese patients with chronic kidney disease: results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). J Transl Med 2019;17(1):86. DOI: 10.1186/s12967-019-1808-4.
  10. Altunoren O, Akkus G, Sezal DT, Ciftcioglu M, Guzel FB, Isiktas S, et al. Does neutrophil to lymphocyte ratio really predict Chronic Kidney Disease progression? Int Urol Nephrol 2019;51(1):129–137. DOI: 10.1007/s11255-018-1994-7.
  11. Nugraha HP, Sudjana P. Gambaran karakteristik pasien sepsis dengan nilai KHM dari terapi empiris antibiotika golongan sefalosporin di instalasi rawat inap Rumah Sakit Dr. Hasan Sadikin Universitas Padjajaran 2016 (Bandung).
  12. Stepko B, Coundary. What causes this surprisingly large health threat and how to prevent it – in and out of the hospital. American Association of Retired Persons; 2018.
  13. Pantzaris ND, Platanaki C, Pierrako C, Karamouzos V, Velissaris D. Neutrophil-to-lymphocyte ratio relation to sepsis severity scores and inflammatory biomarkers in patients with communityacquired pneumonia: a case series. J Transl Int Med 2018;6(1):43–46. DOI: 10.2478/jtim-2018-0009.
  14. De Jager CPC, Wever PC, Gemen EFA, Kusters R, van Gageldonk-Lafeber AB, van der Poll T, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One 2012;7(10):e46561. DOI: 10.1371/journal.pone.0046561.
  15. De Jager CP, Van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 2010;14(5):R192. DOI: 10.1186/cc9309.
  16. Gürol G, Çiftci İH, Terizi HA, Atasoy AR, Ozbek A, Köroğlu M. Are there standardized cut-off values for neutrophil-lymphocyte ratios in bacteremia or sepsis? J Microbiol Biotechnol 2015;25(4):521–525. DOI: 10.4014/jmb.1408.08060.
  17. Hessle C, Andersson B, Wold AE. Gram-positive bacteria are potent inducers of monocytic interleukin-12 (IL-12) while Gram-negative bacteria preferentially stimulate IL-10 production. Infect Immun 2000;68(6):3581–3586. DOI: 10.1128/IAI.68.6.3581-3586.2000.
  18. Feldman C, Alanee S, Yu VL, Richards GA, Ortqvist A, Rello J, et al. Severity of illness scoring systems in patients with bacteraemic pneumococcal pneumonia: implications for the Intensive Care Unit Clin Microbiol Infect 2009;15(9):850–857. DOI: 10.1111/j.1469-0691.2009.02901.x.
  19. George AA, Thomas TP, Gaffoor A. The role of neutrophil/lymphocyte ratio in predicting the severity of sepsis in a tertiary care hospital in South India: a retrospective study. Int J Res Med Sci 2020;8(5). DOI: 10.18203/2320-6012.ijrms20201490.
  20. Rehman FU, Khan A, Aziz A, Iqbal M, Mahmood SBZ, Ali N. Neutrophils to lymphocyte ratio: earliest and efficacious markers of sepsis. Cureus 2020;12(10):e10851. DOI: 10.7759/cureus.10851.
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