ORIGINAL ARTICLE
The role of hematological parameters in estimating nosocomial sepsis
 
More details
Hide details
1
Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
2
Infection Control Committee, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
3
Department of Community Health Nursing, Abant Izzet Baysal University Nursing School, Bolu, Turkey
Online publish date: 2019-05-16
Publish date: 2019-05-16
 
Electron J Gen Med 2019;16(3):em139
KEYWORDS
TOPICS
ABSTRACT
Background:
Sepsis is a systemic inflammatory condition with high mortality rate. It is important to estimate nosocomial sepsis in order to manage the patients earlier. The aim of this study was to investigate the role of hematological parameters in estimating nosocomial sepsis.

Material and Methods:
A retrospective examination was conducted on 121 nosocomial sepsis patients between 01 January 2014 and 30 June 2017. Neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP) of the patients at the onset of sepsis were compared with baseline values.

Results:
The mean CRP level of the cohort at admission was 55±5.4 mg/dL and 139.2±6.2 mg/dL at the onset of sepsis (p<0.001). The mean NLR at admission was 10.64±10.6 and 13.69±14.5 at the onset of sepsis (p=0.037). In contrast, the differences in white blood cell, and mean platelet volume values at admission and sepsis onset were not statistically significant (p>0.05). Significant correlation was found between CRP and NLR values at both admission (r=0.365, p<0.001) and at the onset of sepsis (r=0.261, p=0.004).

Conclusion:
We concluded that the NLR is a useful marker in estimating nosocomial sepsis especially when considered together with CRP.

 
REFERENCES (24)
1.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32. https://doi.org/10.1016/j.ajic... PMid:18538699.
 
2.
Nagao M. A multicentre analysis of epidemiology of the nosocomial bloodstream infections in Japanese university hospitals. Clin Microbiol Infect 2013;19:852-8. https://doi.org/10.1111/1469-0... PMid:23176224.
 
3.
Grace CJ, Lieberman J, Pierce K, Littenberg B. Usefulness of blood culture for hospitalized patients who are receiving antibiotic therapy. Clin Infect Dis 2001;32:1651-5. https://doi.org/10.1086/320527 PMid:11340541.
 
4.
Lowsby R, Gomes C, Jarman I, et al. Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department. Emerg Med J 2015;32:531-4. https://doi.org/10.1136/emerme... PMid:25183249.
 
5.
Hwang SY, Shin TG, Jo IJ, et al.Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017;35:234-9. https://doi.org/10.1016/j.ajem... PMid:27806894.
 
6.
Zhang HB, Chen J, Lan QF, Ma XJ, Zhang SY. Diagnostic values of red cell distribution width, platelet distribution width and neutrophil-lymphocyte count ratio for sepsis. Exp Ther Med 2016;12:2215-9. https://doi.org/10.3892/etm.20... PMid:27698714 PMCid:PMC5038364.
 
7.
Aydemir H, Piskin N, Akduman D, Kokturk F, Aktas E. Platelet and mean platelet volume kinetics in adult patients with sepsis. Platelets 2015;26(4):331-5. https://doi.org/10.3109/095371... PMid:22731700.
 
8.
Loonen AJM, de Jager CPC, Tosserams J, et al. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS One 2014;9:e87315. https://doi.org/10.1371/journa... PMid:24475269 PMCid:PMC3903623.
 
9.
de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 2010;14:R192. https://doi.org/10.1186/cc9309 PMid:21034463 PMCid:PMC3219299.
 
10.
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801-10. https://doi.org/10.1001/jama.2... PMid:26903338 PMCid:PMC4968574.
 
11.
Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med 2015; 372:1629-38. https://doi.org/10.1056/NEJMoa... PMid:25776936.
 
12.
Churpek MM, Zadravecz FJ, Winslow C, Howell MD, Edelson DP. Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients. Am J Respir Crit Care Med 2015;192:958-64. https://doi.org/10.1164/rccm.2... PMid:26158402 PMCid:PMC4642209.
 
13.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017;45:486-552. https://doi.org/10.1097/CCM.00... PMid:28098591.
 
14.
Westerdijk K, Simons KS, Zegers M, Wever PC, Pickkers P, de Jager CPC. The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study. PLoS One 2019;14:e0212861. https://doi.org/10.1371/journa... PMid:30811475 PMCid:PMC6392273.
 
15.
Manohar V, Prasad SB, Raj S, Sreekrishnan TP, Gireesh Kumar KP. The Eminence of Neutrophil-lymphocyte Count Ratio in Predicting Bacteremia for Community-acquired Infections at an Emergency Medicine Department in a Tertiary Care Setting. J Emerg Trauma Shock 2018;11:271-5. https://doi.org/10.4103/JETS.J... PMid:30568369 PMCid:PMC6262656.
 
16.
Sen P, Demirdal T, Nemli SA, et al. Infection markers as predictors of Bacteremia in an Intensive Care Unit: A prospective study. Pak J Med Sci 2018;34(6):1517-24. https://doi.org/10.12669/pjms.... PMid:30559815 PMCid:PMC6290214.
 
17.
Fuss J, Voloboyeva A, Poliovyj V. Prognostic value of using neutrophil-lymphocyte ratio in patients with burn injury for the diagnosis of sepsis and bacteraemia. Pol Przegl Chir 2018;90(5):13-6. https://doi.org/10.5604/01.300... PMid:30426944.
 
18.
Kaushik R, Gupta M, Sharma M, et al. Diagnostic and Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Early and Late Phase of Sepsis. Indian J Crit Care Med 2018;22(9):660-3. https://doi.org/10.4103/ijccm.... PMid:30294133 PMCid:PMC6161585.
 
19.
Hwang SY, Shin TG, Jo IJ, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017;35(2):234-9. https://doi.org/10.1016/j.ajem... PMid:27806894.
 
20.
Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Patients with Sepsis: A Prospective Observational Study. Mediators Inflamm 2016;2016:8191254. https://doi.org/10.1155/2016/8... PMid:27110067 PMCid:PMC4823514.
 
21.
Riché F, Gayat E, Barthélémy R, Le Dorze M, Matéo J, Payen D. Reversal of neutrophil-to-lymphocyte count ratio in early versus late death from septic shock. Crit Care 2015;19:439. https://doi.org/10.1186/s13054... PMid:26671018 PMCid:PMC4699332.
 
22.
Yang M, Li L, Su N, Lin J, Wang J. [Dynamic monitoring of the neutrophil/lymphocyte ratio could predict the prognosis of patients with bloodstream infection]. Zhonghua Wei Zhong Bing JiJiu Yi Xue 2015;27:471-6. https://doi.org/10.3760/cma.j.... PMid:26049186.
 
23.
Akilli NB, Yortanlı M, Mutlu H, et al. Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes. Am J Emerg Med 2014;32:1476-80. https://doi.org/10.1016/j.ajem... PMid:25264245.
 
24.
Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection 2017;45:299-307. https://doi.org/10.1007/s15010... PMid:27995553 PMCid:PMC5488068.
 
eISSN:2516-3507