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Neutrophil-to-Lymphocyte Ratio and Systemic Inflammatory Response Index as Predictors of In-Hospital Mortality in
Dewi Kartika Turbawaty1, Ananda Dewa1, Agnes Rengga Indrati1
1Department of Clinical Pathology, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
Purpose:
Ventilator-associated pneumonia (VAP) is a common complication in intensive care units (ICUs) with high mortality rates. Early risk stratification is often limited by the lack of availability of complex prognostic scoring and microbiology turnaround time. This study aimed to assess the neutrophil-to-lymphocyte ratio (NLR) and systemic inflammatory response index (SIRI) on the day of VAP diagnosis as predictors of in-hospital mortality.
Patients And Methods:
We conducted a retrospective cohort study using secondary data from mechanically ventilated adult patients with VAP admitted to Hasan Sadikin General Hospital (a tertiary referral hospital in Bandung, Indonesia) from January 1, 2021 to December 31, 2022. VAP was confirmed by chart review using standard clinical and radiologic criteria occurring ≥48 hours after the start of mechanical ventilation, with endotracheal aspirate culture when available. The primary outcome was all-cause in-hospital mortality (death before hospital discharge). NLR and SIRI were calculated from the first complete blood count on the day of VAP diagnosis. Optimal cut-offs were determined using ROC analysis (Youden index). Survival was analyzed from VAP diagnosis until death or discharge.
Results:
Among 87 patients, 68 died in hospital and 19 survived to discharge. NLR had excellent discriminatory power for in-hospital mortality (AUC 0.981); a cut-off >11 had 100% sensitivity and 89.5% specificity. SIRI had good discriminatory power (AUC 0.860); a cut-off >16 had 64.7% sensitivity and 100% specificity. In univariable Cox models, NLR >11 was associated with increased mortality risk (HR 29.07; 95% CI 2.24-376.92), whereas SIRI >16 showed a non-significant trend (HR 1.55; 95% CI 0.93-2.57).
Conclusion:
NLR and SIRI obtained on the day of VAP diagnosis are simple, non-invasive laboratory markers that could aid in early risk stratification for in-hospital mortality in VAP. These markers should not replace but rather complement established clinical severity assessment and treatment decisions.
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