Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Jul 29;24(1):749.
doi: 10.1186/s12879-024-09516-5.

Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio associated with 28-day all-cause mortality in septic patients with coronary artery disease: a retrospective analysis of MIMIC-IV database

Xicong Li #  1   2 , Yubiao Chen #  3   4 , Qi Yuan  1   2 , Hongya Zhou  1   2 , Lifei Lu  5 , Ruiwei Guo  6
Affiliations
Observational Study

Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio associated with 28-day all-cause mortality in septic patients with coronary artery disease: a retrospective analysis of MIMIC-IV database

Xicong Li et al. BMC Infect Dis. .

Abstract

Background: High Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR) were associated with worse prognosis of patients with sepsis. In-hospital mortality has been reported to be higher in patients with coronary artery disease (CAD) and sepsis than those with sepsis alone. However, the relationship between NLR, MLR, PLR and mortality in septic patients with coronary artery disease (CAD) remains unclear. The study aimed to explore the association between NLR, MLR, PLR and 28-day all-cause mortality in septic patients with CAD.

Methods: We performed an observational cohort study of septic patients with CAD from the Medical Information Mart for Intensive Care (MIMIC)-IV database between 2008 and 2019. The patients were categorized by three group (Q1: low levels, Q2: medium levels, Q3: high levels) based on tertiles of NLR, MLR, and PLR. The associations between NLR, MLR, PLR and 28-day all-cause mortality were examined using the Cox proportional hazards model. Subsequently, we applied receiver operating characteristic (ROC) analysis for predicting 28-day mortality in septic patients with CAD by combining NLR, MLR and PLR with the modified sequential organ failure assessment (mSOFA) scores.

Results: Overall 1,175 septic patients with CAD were included in the study. Observed all-cause mortality rates in 28 days were 27.1%. Multivariate Cox proportional hazards regression analysis results showed that 28-day all-cause mortality of septic patients with CAD was significantly related to rising NLR levels (adjusted hazard ratio [aHR]: 1.02; 95% confidence interval [CI]: 1.01-1.02; P < 0.001), MLR levels (aHR: 1.29; 95%CI: 1.18-1.41; P < 0.001), and PLR levels (aHR: 1.0007; 95%CI: 1.0004-1.0011; P < 0.001). Meanwhile, the higher levels (Q3) group of NLR, MLR, and PLR also had a higher risk of 28-day all-cause mortality than the lower (Q1) group. The area under the ROC curve of NLR, MLR, PLR, and mSOFA score were 0.630 (95%CI 0.595-0.665), 0.611 (95%CI 0.576-0.646), 0.601 (95%CI 0.567-0.636) and 0.718 (95%CI 0.689-0.748), respectively. Combining NLR, MLR, and PLR with mSOFA scores may improve ability of predicting 28-day mortality (AUC: 0.737, 95%CI 0.709-0.766).

Conclusion: Higher levels of NLR, MLR and PLR were associated with 28-day all-cause mortality in septic patients with CAD. Further investigation will be needed to improve understanding of the pathophysiology of this relationship.

Keywords: Biomarker; Coronary artery disease; Sepsis; Sequential organ failure assessment scores.

PubMed Disclaimer

Conflict of interest statement

The authors of this study have no conflicts of interest.

Figures

Fig. 1
Fig. 1
The flow chart of inclusion and exclusion
Fig. 2
Fig. 2
Kaplan‒Meier analysis analysis of the difference among different levels of inflammatory biomarkers
Fig. 3
Fig. 3
Prediction value of 28-day mortality in septic patients with CAD NLR: Neutrophil-to-Lymphocyte ratio; MLR: Monocyte-to-Lymphocyte ratio, PLR; Platelet-to-Lymphocyte ratio; mSOFA; modified sequential organ failure assessment
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Machado FR, Cavalcanti AB, Bozza FA, Ferreira EM, Angotti Carrara FS, Sousa JL, Caixeta N, Salomao R, Angus DC, Pontes Azevedo LC. The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study. Lancet Infect Dis. 2017;17:1180–9. 10.1016/S1473-3099(17)30322-5 - DOI - PubMed
    1. Incidence of severe sepsis. And septic shock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med. 2016;42:1980–9. 10.1007/s00134-016-4504-3 - DOI - PubMed
    1. Kern H, Wittich R, Rohr U, Kox WJ, Spies CD. Increased endothelial injury in septic patients with coronary artery disease. Chest. 2001;119:874–83. 10.1378/chest.119.3.874 - DOI - PubMed
    1. Dolmatova EV, Wang K, Mandavilli R, Griendling KK. The effects of sepsis on endothelium and clinical implications. Cardiovasc Res. 2021;117:60–73. 10.1093/cvr/cvaa070 - DOI - PMC - PubMed
    1. Lv X, Wang H. Pathophysiology of sepsis-induced myocardial dysfunction. Mil Med Res. 2016;3:30. - PMC - PubMed

Publication types

LinkOut - more resources