NEUTROPHIL TO LYMPHOCYTE RATIO VS PROCALCITONIN AS A MARKER FOR SEVERITY OF SEPSIS

Dr. Ankit P. Bhojani* and Dr. Yogitha C.

ABSTRACT

Background: Severe sepsis and septic shock, are the major cause of emergency room admission and are associated with high morbidity and mortality worldwide. Similarly mortality rate of sepsis in asia found to be 40%, so sepsis is still the leading cause of death. Delayed identification and inadequate resuscitation in severe sepsis and septic shock leads to the high mortality. We compared the accuracy of the neutrophil-lymphocyte count ratio (N/L) to conventional inflammatory markers in patients admitted to the Intensive Care Unit. Methods: The current study was a retrospective study performed in KIMS hospital Bangalore. The study cohort consisted of 50 patients admitted to the medicine ICU/MICU. Patients were admitted to the ICU when they had manifest or imminent organ failure, especially circulatory, respiratory or renal failure All patients age more than 18 admitted with sepsis were included in the study. In the current study, patients with a known or probable immune deficiency were excluded, including patients with a haematological disease, patients treated with chemotherapy or immunosuppressive therapy including glucocorticoids. Procalcitonin levels and all routine investigations including investigations to find out source of sepsis were documented.Neutrophil/lymphocyte ratio was calculated, APACHE score and PCT were documented.all these parameters were compared based on outcome of the patient. Results: Significant differences in N/L ratio values were observed between sepsis and non-sepsis patients (12.3 vs. 2.4 ; P<0.001) The area under the ROC curve of the NLCR was 0.78. AUROC was significantly higher for PCT 0.86. APACHE 2 score correlated well with procalcitonin levels and the N/L ratio was found to be higher in the sepsis group than the non sepsis group. Conclusion: In the very busy emergency room where calculating APACHE 2 score or other scoring systems for sepsis is time consuming and expensive,other less expensive and time saving markers need to be implemented one such marker is the Neutrophil to lymphocyte ratio which can be calculated to assess the severity of sepsis but prognosis does not correlates well with serum procalcitonin levels and APACHE 2 score.

Keywords: Sepsis, Septic shock, procalcitonin, neutrophil lymphocyte ratio.