Association between 30-day mortality and serially measured hematologic markers in patients with septic shock in South...

Hematologic markers derived from complete blood counts have emerged as potential cost-effective prognostic indicators. Sepsis-induced left ventricular diastolic dysfunction (LVDD) is associated with increased mortality rates. We evaluated the predictive value of serially measured hematologic markers for 30-day mortality and their relationship with LVDD in patients with septic shock.

This retrospective cohort study analyzed adult patients diagnosed with septic shock in the emergency department of a university hospital between March 2014 and May 2018. Serial neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio (LMR) values were recorded from admission to day 5. The relationship between hematologic markers and LVDD was evaluated in patients who underwent transthoracic echocardiography (TTE).

In total, 431 patients were included, with a 30-day mortality rate of 12.5%. The NLR on day 5 and NLR day 5/day 1 ratio had the highest predictive performance (area under the receiver operating characteristic curve [AUROC], 0.743 and 0.746, respectively). Similarly, the LMR on day 5 and the LMR day 5/day 1 ratio showed strong prognostic value (AUROC, 0.707 and 0.753, respectively). In the subgroup analysis of 204 patients who underwent TTE, a higher NLR at admission was significantly associated with LVDD (odds ratio, 1.016; 95% CI, 1.000-1.031; P=0.043).

Serial measurements of the NLR and LMR showed better predictive value for 30-day mortality in patients with septic shock than measurements from a single time point. These findings support the use of hematologic markers as adjunctive tools for risk stratification of patients with septic shock.