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Cited by 268Sepsis Diagnosis and TreatmentInflammatory Biomarkers in Disease PrognosisInflammation biomarkers and pathways

Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia?

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Djordjevic, Dragan, Rondovic, Goran, Surbatovic, Maja, Stanojevic, Ivan, Udovicic, Ivo, Andjelic, Tamara, Zeba, Snjezana, Milosavljevic, Snezana +4 more·2018·Mediators of Inflammation
DOI 10.1155/2018/3758068PMC PMC6079471
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Abstract

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet count (MPV/PC) ratio are readily available parameters that might have discriminative power regarding outcome. The aim of our study was to assess prognostic value of these biomarkers regarding outcome in critically ill patients with secondary sepsis and/or trauma. METHODS: A total of 392 critically ill and injured patients, admitted to surgical ICU, were enrolled in a prospective observational study. Leukocyte and platelet counts were recorded upon fulfilling Sepsis-3 criteria and for traumatized Injury Severity Score > 25 points. Patients were divided into four subgroups: peritonitis, pancreatitis, trauma with sepsis, and trauma without sepsis. RESULTS: NLR and MPV/PC levels were significantly higher in nonsurvivors (AUC/ROC of 0.681 and 0.592, resp., in the peritonitis subgroup; 0.717 and 0.753, resp., in the pancreatitis subgroup); MLR and PLR did not differ significantly. There was no significant difference of investigated biomarkers between survivors and nonsurvivors in trauma patients with and without sepsis except for PLR in the trauma without sepsis subgroup (significantly higher in nonsurvivors, AUC/ROC of 0.719). Independent predictor of lethal outcome was NLR in the whole cohort and in the peritonitis subgroup as well as MPV in the pancreatitis subgroup. Also, there were statistically significant differences in MPV/PC, MLR, and PLR values regarding nature of bacteremia. In general, the lowest levels had been found in patients with Gram-positive blood cultures. CONCLUSIONS: NLR and MPV were very good independent predictors of lethal outcome. For the first time, we demonstrate that nature of bacteremia influences MPV/PC, MLR, and PLR. In heterogeneous cohort subgroup, analysis is essential.

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  • ICRs have been repeatedly proposed as solid prognostic markers for various additional conditions including low-grade inflammation, rheumatic diseases, sepsis, myocarditis, thrombosis, ischemic and cardiovascular events, autoimmune and systemic diseases, cancer incidence, progression, response and outcome, COVID-19 severity and prognosis, critical illness, and overall mortality.

    “Since then, IRCs have been repeatedly proposed as solid prognostic markers for various additional conditions including low-grade inflammation, rheumatic diseases, sepsis, myocarditis, thrombosis, ischemic and cardiovascular events, autoimmune and systemic diseases, cancer incidence, progression, response and outcome, COVID-19 severity and prognosis, critical illness, and overall mortality [26,27,2”

    From Immune Cell Ratios Are Higher in Bipolar Affective than Unipolar Depressive Disorder and Modulated by Mood Episode: A Retrospective, Cross-Sectional Study (2023) · cites this paper as [28]

    The Introduction (page unavailable) describes blood-count ratios as potential biomarkers in critical illness and secondary sepsis, with hospital mortality as the study outcome. The Discussion (page unavailable) reports prognostic findings for some ratios, but also says MLR had no independent prognostic significance; the Introduction notes mixed results and no consensus on clinical usefulness. This supports the critical-illness, sepsis, and mortality portion of the multi-citation claim, not the characterization of these ratios as uniformly solid markers across the full list of conditions. (LLM, conf=0.86)

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Authors
Djordjevic, D., Rondovic, G., Surbatovic, M., Stanojevic, I., Udovicic, I., Andjelic, T., Zeba, S., Milosavljevic, S., Stankovic, N., Abazovic, D., Jevdjic, J., & Vojvodic, D.
Affiliations
  • Military Medical Academy (RS)
  • Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia
  • Faculty of Medicine, Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia
  • Department of Anesthesiology, Clinical Hospital Center Kosovska Mitrovica, Anri Dinana bb, 38220 Kosovska Mitrovica, Serbia
  • Department of Anesthesiology and Intensive Therapy, Mother and Child Health Care Institute of Serbia, Radoja Dakica 8, 11000 Belgrade, Serbia
  • Emergency Medical Center of Montenegro, Vaka Djurovica bb, 81000 Podgorica, Montenegro
  • Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia
ORCID
Surbatovic, Maja
Venue
Mediators of Inflammation
Publisher
Wiley
Published
2018-07-15
Volume
2018
Pages
1-15
ISSN
  • 0962-9351 (ISSN-L)
  • 1466-1861
DOI
10.1155/2018/3758068
PMC
PMC6079471
OpenAlex
W2884987974
Cited by
268
References
1
Citations by year
2026: 13 · 2025: 40 · 2024: 54 · 2023: 32 · 2022: 40 · 2021: 44 · 2020: 35 · 2019: 10
FWCI
17.37
Type
journal article
Language
en
Open access
Licence
Locations
  • Mediators of Inflammation (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
  • Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
Keywords
neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, inflammatory markers, secondary sepsis, trauma (physical injury), critically ill patients, mortality prediction, bacteremia, gram-positive bacteremia, peritonitis, pancreatitis, prognostic factors
MeSH terms
Adult, Aged, Blood Platelets, Female, Humans, Intensive Care Units, Leukocyte Count, Male, Middle Aged, Monocytes, Neutrophils, Pancreatitis, Peritonitis, Platelet Count, Prognosis, Prospective Studies, Wounds and Injuries, Biomarkers, Bacteremia, Critical Illness, Treatment Outcome, Sepsis, Mean Platelet Volume

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