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KMID : 0385920230340030230
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Journal of the Korean Society of Emergency Medicine
2023 Volume.34 No. 3 p.230 ~ p.240
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Usefulness of the delta neutrophil index to lymphocyte ratio to predict prognosis in sepsis patients in the emergency department
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Jang Young-Bin
Chung Sung-Phil
You Je-Sung
Kong Tae-Young
Ko Dong-Ryul
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Abstract
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Objective: This study verifies the practicality of the delta neutrophil index to lymphocyte ratio for the prognostic evaluation of sepsis patients.
Methods: Records of 2,233 patients diagnosed with sepsis were reviewed; 1,042 patients were included in the final analysis. Receiver operating characteristic (ROC) curve studies were used to calculate the area under the curve (AUC) to determine the neutrophil-to-lymphocyte ratio (NLR) and the delta neutrophil-to-lymphocyte ratio (Delta-NLR). To adjust for skewed distributions, the NLR and Delta-NLR were analyzed after natural logarithm transformations. Multivariate logistic regression was applied to determine potential predictors for mortality.
Results: To predict 30-day mortality, AUCs were performed using the values of days 0, 1, and 2 (0.604, P<0.0001; 0.648, P<0.0001; and 0.684, P<0.0001, respectively). The NLR results were 0.504 (P=0.8624), 0.553 (P=0.0191), and 0.598 (P<0.0001), respectively. The AUC increased significantly when the Delta-NLR at day 0 was combined with age, hemoglobin levels, and lactate levels. Further subgroup analysis was performed by dividing patients into an upper respiratory infection (URI) group, a gastrointestinal tract infection (GI) (including hepatobiliary infection) group, and a urinary tract infection (UTI) group. The predictive ability of the GI group was determined to be much higher than the other two groups.
Conclusion: Increase in the Delta-NLR of sepsis patients was found to be an independent predictor of mortality within 30 days.
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KEYWORD
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Sepsis, Mortality, prognose, Biomarkers, Neutrophils, Lymphocytes
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