Avaliação da relação neutrófilo/linfócito como indicador prognóstico em pacientes sépticos de unidades de terapia intensiva de Recife-PE
Evaluation of neutrophil-to-lymphocyte ratio as a prognostic indicator in septic patients in intensive care units in Recife-PE
Filipe Jonas Federico da-Cruz; Filipe Prohaska Batista; Renata Barretto Coutinho Bezerra e Silva
Resumo
Introdução: Sepse é uma síndrome de resposta inflamatória sistêmica associada a foco infeccioso e às disfunções orgânicas. Sabe-se que, no processo infeccioso, a resposta do hospedeiro consiste no aumento do número de neutrófilos e na redução do número total de linfócitos. O índice neutrófilo/linfócito (N/L) é uma ferramenta facilmente calculável a partir do hemograma, e tem sido utilizada como indicador prognóstico em diversas condições patológicas. Esta pesquisa visa avaliar o valor prognóstico das médias da relação neutrófilo-linfócito em pacientes sépticos em unidades de terapia intensiva de Recife-PE, Brasil. Metodologia: Foram coletados de registros em prontuário eletrônico os hemogramas de admissão, do segundo dia (D2) e sétimo (D7) dias após internamento em unidades de terapia intensiva (UTI). A relação neutrófilo/linfócito foi calculada pela divisão entre os valores absolutos das contagens celulares. As médias encontradas foram comparadas com: dias de internamento em UTI, tempo de ventilação mecânica, tempo de droga vasoativa e mortalidade em 28 dias. Resultados: O valor médio da relação N/L que teve correlação com mortalidade em 28 dias foi de 14,2 no D1 (p = 0,011) e 15,9 no D7 (p < 0,001). Ao avaliar-se o risco relativo de mortalidade em 28 dias quando os subgrupos foram reunidos em pacientes sem infecção (N/L < 5) e com infecção (N/L = 5), o oddsratio em D1 foi de 12,0; e em D7 foi de 15,8. Conclusão: O valor da relação N/L na avaliação de pacientes sépticos guarda correlação com mortalidade em 28 dias, e valor médio acima de 14 aumenta consideravelmente este risco.
Palavras-chave
Abstract
Introduction: Sepsis is a syndrome of systemic inflammatory response associated with infectious outbreak and organ dysfunctions. In the infectious process, the host response is known to increase the number of neutrophils and to reduce the total number of lymphocytes. The neutrophil-to-lymphocyte ratio (NLR) can be easily calculated from the blood count and has been used as a prognostic indicator in several pathologic conditions. This study aimed to evaluate the prognostic value of NLR in septic patients in intensive care units (ICUs) in Recife-PE. Methods: Blood counts on ICU admission and on day 2 (D2) and day 7 (D7) after ICU admission were collected from electronic medical records. The NLR was calculated by dividing the absolute values of cell counts. The resulting averages were compared with length of ICU stay, duration of mechanical ventilation, duration of vasoactive drug use, and 28-day mortality. Results: The mean NLR that correlated with 28-day mortality was 14.2 on D1 (p=0.011) and 15.9 on D7 (p<0.001). In the analysis of the relative risk of 28-day mortality for the subgroups of patients without infection (NLR < 5) and with infection (NLR = 5), the odds ratio was 12.0 on D1 and 15.8 on D7. Conclusion: The value of the NLR in the evaluation of septic patients correlates with 28-day mortality, and mean values above 14 significantly increase this risk.
Keywords
Referências
1. Singer M, Deutschman C, Seymour, CW. The third International consensus definitions for sepsis and septic shock (Sepsis 3). JAMA. 2016;31(8):801-10.
2. Sriskanda S, Altmann DM. The immunology of sepsis. J Pathol. 2008;214(2):211‑23.
3. Li J, Li M, Su L, Wang H, Xiao K, Deng J, et al. Alterations of T helper lymphocyte subpopulations in sepsis, severe sepsis, and septic shock: A prospective observational study. Inflammation. 2015;38(3):995‑1002.
4. Holub M, Klucková Z, Beneda B, Hobstová J, Huzicka I, Prazák J, et al. Changes in lymphocite subpopulations and CD3+/DR+ expression in sepsis. Clin Microbiol Infect. 2000;6(12):657-60.
5. Gürol G, Çiftci İH, Terizi HA, Atasoy AR, Ozbek A, Köro lu M. Are there standardized cut-off values for neutrophil-lymphocyte ratio in bacteremia or sepsis? J Microbiol Biotechnol. 2015;25(4):521‑5.
6. Salciccioli JD, Marshall DC, Pimentel MA, Santos MD, Pollard T, Celi LA, et al. The association between neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care. 2015;19(1):13-20.
7. Aires FT, Dedivitis RA, Kulcsar MAV, Ramos DM, Cernea CR. Neutrophil-to-lymphocyte ratio as a prognostic factor for pharyngocutaneous fistula after total laringectomy. Acta Otorhinolaryngol Ital. 2018;38(1):31-7.
8. Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, et al. Neutrophilto-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med. 2017;35(2):234-9.
9. Forget P, Khalifa C, Defour JF, Dominique L, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):12-5.
10. Pantzaris ND, Platanaki C, Pierrako C, Karamouzos V, Velissaris D. Neutrophil-to-lymphocyte ratio relations to sepsis severity scores and inflammatory biomarkers in patients with community-acquired pneumonia: A case series. JTIM. 2018;6(1):43-6.
11. Xuan L, Yong S, Hairong W, Qinmin G, Aihua F, Shuming P. Prognostic significance of neutrophil-to-lymphocyte ratio in patient with sepsis: a prospective observational study. Mediators Inflamm. 2016(2):1-8.
12. Velissaris D, Pantzaris, ND, Gogos C, Bountoris, P. Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 cases. Rom J Intern Med. 2018(56):15357.
13. Cataudella E, Giraffa CM, Di Marca S, Pulvirenti A, Alaimo S, Pisano M, et al. Neutrophil-to-lymphocyte ratio: an emerging predicting prognosis in elderly adults with community acquired pneumonia. J Am Geriat Soc. 2017;65(8):1796-801.
14. Hyder J, Boggs DH, Hanna A, Suntharalingam M, Chuong MD. Changes in neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios during chemoradiation predict for survival and pathologic complete response in trimodality esophageal cancer patients. J Gastrointest Oncol. 2015;7(2):189-95.
15. Santos HO, Izidoro LFM. Relação neutrófilo-linfócito na avaliação do risco para desenvolvimento de doença cardiovascular. Int J Cardiosvasc Sci. 2018;31(5)532-37.
16. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and mortality of hospital-treated sepsis. Am J Respir Crit Care Med. 2016;193(3):259-72.
17. de Jager CPC, van Wijk PTL, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-to-lymphocyte count ratio predict bacteremia better than conventional markers in an emergency care unit. Crit Care. 2010;14(R192):2-8.
18. Kaushik R, Gupta M, Sharma M, Jash D, Jain N, Sinha N, et al. Diagnostic and prognostic role of neutrophil-to-lymphocyte ration in early and late phase of sepsis. Indian J Crit Care Med. 2018;22(9):660-3.
19. Wang Y, Ju M, Chen C, Yang D, Hou D, Tang X, et al. Neutrophilto-lymphocyte ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective study. J Thorac Dis. 2018;10(1):273-82.
20. Fan LL, Wang YJ, Nan CJ, Chen YH, Su HX. Neutrophil-lymphocyte ratio is associated to all-cause mortality among critically ill patients with acute kidney injury. Clin Chim Acta. 2019 Mar;490:207‑13.
21. Zujin L, Yinyin Z, Liu Y, Sijie L, Jian Z, Na Z, et. al. Neutrophil/ lymphocyte ratio is helpful for predicting weaning failure: a prospective, observational cohort study. J Thorac Dis. 2018;10(9):5232-245.
Submetido em:
28/08/2019
Aceito em:
05/09/2019
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