Evaluation of Novel Combined CBC-Derived Systemic Inflammatory Ratios and Their Dynamic Changes as ICU Mortality
Helia Azmakan1, Farshad Hashemian1, Kaveh Kazemian2
1Department of Clinical Pharmacy, Faculty of Pharmacy Tehran Azad University of Medical Sciences Tehran Iran.
Insights
The neutrophil-to-lymphocyte platelet ratio (NLPR) 48 hours after ICU admission and its changes within the first 48 hours are significant predictors of mortality in critically ill patients. These accessible markers can aid in predicting outcomes, especially where standard scoring systems are unavailable.
Area of Science:
- Critical Care Medicine
- Biomarker Research
- Inflammation Markers
Background:
- Novel inflammatory biomarkers show prognostic value in intensive care units (ICUs).
- Existing research highlights potential for markers like neutrophil-to-lymphocyte ratio (NLPR) in predicting outcomes.
- Evaluating these markers in diverse ICU populations is crucial for clinical application.
Purpose of the Study:
- To assess the predictive capability of various inflammatory parameters for ICU mortality.
- To investigate the prognostic value of NLPR and its dynamic changes within the first 48 hours of ICU admission.
- To validate these predictors in a heterogeneous cohort of critically ill patients.
Main Methods:
- Retrospective cohort study of 311 ICU patients.
- Evaluation of inflammatory parameters at admission and 48 hours post-admission.
- Multivariate logistic regression, ROC curves, and calibration curves for validation.
Main Results:
- NLPR at 48 hours post-ICU admission and its changes within 48 hours significantly predicted ICU mortality (p < 0.001 and p = 0.018, respectively).
- The model incorporating 48-hour NLPR demonstrated the highest predictive accuracy (AUC 0.8671) and best calibration.
- Predictive performance of NLPR dynamic changes was reduced in patients with cerebrovascular accident (CVA).
Conclusions:
- NLPR levels at 48 hours and their dynamic changes are significant predictors of ICU mortality in heterogeneous critically ill patients.
- These findings offer practical, accessible tools for mortality prediction in ICUs.
- The study underscores the utility of NLPR in settings lacking routine traditional scoring systems.
Background And Aims:
Novel biomarkers, such as neutrophil lymphocyte ratio, monocyte lymphocyte ratio, neutrophil to lymphocyte platelet ratio, derived neutrophil to lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and aggregate index of systemic inflammation, have shown promising prognostic value, especially in ICU settings. We aimed to evaluate the potential of the mentioned factors as ICU mortality predictors in a heterogeneous ICU cohort.
Methods And Materials:
We conducted a retrospective cohort study using data obtained from the intensive care unit (ICU) records of 311 patients. We evaluated the strength of the inflammatory parameters upon admission, 48 h later, and their dynamic changes within this period in predicting ICU mortality. We used multivariate logistic regression with backward elimination, which were further validated using ROC and calibration curves. Interaction terms were added to assess the possible modifications in predictive performance of ratios across various subgroups of patients.
Results:
NLPR, 48 h post ICU admission (p < 0.001, OR: 7.3436, 95% CI: 3.2986-17.2619) and NLPR changes during the first 48 h of ICU admission (p = 0.018, OR: 2.3826, 95% CI: 1.2069-6.7112), were significant predictors of ICU mortality in the multivariate logistic regression models. The model, including 48-h NLPR, had the highest AUC of ROC, calibration slope, and lowest AIC (0.8671, 0.8622, and 229.12, respectively). Also, the predictive performance of NLPR dynamic changes decreases significantly among patients with a background of CVA.
Conclusions:
NLPR level, 48 h post-ICU admission and its dynamic changes during the first 48 h of ICU stay, significantly predict ICU mortality among heterogeneous critically ill patients. These findings can serve as practical and accessible predictors of ICU mortality, particularly in settings, where traditional scoring systems may not be routinely available.
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