Neutrophil-lymphocyte Count Ratio as an Indicator of Culture Positive versus Culture Negative Sepsis: A Single-centre Cross-sectional Study

Abstract

Introduction: In sepsis patients, the Neutrophil-lymphocyte Count Ratio (NLCR) is a laboratory statistic that can indicate bacterial infection. Aim: To measure NLCR in patients with sepsis and compare the NLCR in patient with culture positive and culture negative sepsis. Materials and Methods: This single-centre, cross-sectional study was conducted in the Department of General Medicine at R.L. Jalappa Hospital (Sri Devaraj URS Medical College), Kolar, Karnataka, India, from October 2021 to December 2021. A total of 120 patients above 18 years of age with sepsis, diagnosed as per the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), were included in the study. Participants were evaluated for sepsis and septic shock (society of critical care medicine conference definitions) the principles of initial resuscitation (fluid therapy, vasopressors, inotropic support), and infection issues (source identification and control, appropriate antibiotic therapy) were followed regularly and the outcome studied. Neutrophil count, lymphocyte count, and calculation of NLCR were done at the time of admission. The correlation studies of NLCR in culture-positive and culture-negative was done and compared. Data was analysed by using coGuide software (version 1.03). Results: The mean age of patients was 58.98±17.78 years, ranged from 20 to 96 years, 47 (39.17%) were male and 73 (60.83%) were female, majority 93 (77.50%) out of 120 patients had fever. Majority 78 (65%) had type 2 diabetes mellitus. Neutrophil-to-Lymphocyte ratio (NLR) was 10±1.67, ranging from 7.40 to 14.50. The area under the ROC curve was 0.522. There was no statistically significant relationship between the NLCR and culture report (p-value=0.216). The NLCR had poor predictive validity in predicting culture positive, as indicated by the area under the curve {0.522 (95% CI: 0.417 to 0.626, p-value= 0.988)}. Conclusion: NLCR can be considered as predictor for the initiation of treatment of patients with sepsis.

Keywords

• inotropic support
• resuscitation
• septic shock
• vital signs