Neutrophil-to-lymphocyte ratio predicts mortality for sepsis-induced coagulopathy: a retrospective study

Sepsis often leads to coagulation dysfunction, potentially progressing to disseminated intravascular coagulation (DIC), leading to higher mortality. Sepsis-induced coagulopathy (SIC), an early stage of DIC, benefits from early detection and intervention. Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in inflammatory diseases, but its link to SIC mortality is unclear. This study explored NLR's relevance to clinical outcomes in SIC patients.

SIC patients from the MIMIC-IV database were divided into four groups by NLR quartiles. The primary outcome was 28-day mortality, while secondary outcomes included 90-day and 1-year mortality, intensive care unit (ICU) and hospital mortality. The association between NLR and clinical outcomes in SIC patients was analyzed using Kaplan-Meier, Cox proportional hazards regression analysis, and restricted cubic spline (RCS) analysis.

Among 5323 SIC patients (60.49% male), the median NLR was 7.64 (IQR: 4.30-14.82). The 28-day mortality rate was 16.96% (903), with a higher NLR in non-survivors (12.01 vs. 7.02, P < 0.001), and with a difference of 4.99 (95% CI 3.38-4.62; Z = 13.5). Kaplan-Meier curves showed that higher NLR was linked to increased short- and long-term mortality. Adjusted Cox proportional hazards regression analysis showed that elevated NLR was significantly associated with increased 28-day mortality (HR: 1.36; 95% CI 1.16-1.59; P < 0.001). RCS analysis indicated a J-shaped relationship between NLR and mortality, with the lowest risk at the second quartile (Q2). ROC analysis showed that NLR had modest predictive value for mortality risk, with an AUC of 0.642 (95% CI 0.622-0.663) for 28-day mortality.

NLR is significantly associated with mortality in SIC patients and can predict short-and long-term mortality. This finding suggests that the NLR may be useful in identifying patients with SIC at high risk of mortality. Elevated NLR is significantly associated with increased mortality in SIC patients and can predict short-and long-term mortality. The relationship between NLR and mortality risk is J-shaped, with the lowest risk observed in the second quartile. While NLR demonstrates modest predictive value, its accessibility and ease of use make it a potentially valuable tool for early risk stratification and informing clinical decision-making in SIC patients, especially in emergencies or resource-limited settings.