Bou Chebl Ralphe, Haidar Saadeddine, Kattouf Nadim, Assaf Mohamad, Alwan Joudie Sahar, Khamis Mohamad Moustafa, Abdeldaem Karim, Makki Maha, Tamim Hani, Abou Dagher Gilbert
Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
Open Access Emerg Med. 2025 Jan 20;17:3-13. doi: 10.2147/OAEM.S486966. eCollection 2025.
Lactate has long been recognized as a key prognostic biomarker in sepsis. Similarly, the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) has been investigated in various conditions, including sepsis. Previous studies have explored the optimal NLR cutoff to differentiate sepsis survivors from nonsurvivors, predict bacteremia, diagnose sepsis, and assess mortality. This study compares the prognostic value of lactate and NLR in septic patients.
This prospective cohort study included 874 adult septic or septic shock patients presenting to a tertiary care center's Emergency Department between September 2018 and February 2021. The primary outcome was to compare the prognostic value of NLR and lactate regarding in-hospital mortality. Secondary outcomes compared their prognostic value in different septic subgroups.
Stepwise logistic regression showed NLR was not associated with in-hospital mortality (OR=1.003, p=0.544), while lactate was significantly associated with in-hospital mortality (OR=1.188, p<0.0001). There was no significant difference in the AUCs of NLR and lactate (0.552 vs 0.591, p=0.22). Lactate outperformed NLR in patients with albumin <30, those <65 years old, and those with sepsis from a urinary tract infection. No significant differences were found in AUCs between lactate and NLR in patients with septic shock, Lactate<2, Lactate≥2, diabetes, malignancy, chronic kidney diseases, other sources of infection, albumin ≥30 and age ≥ 65.
In this study, lactate but not NLR was associated with in-hospital mortality. There was no significant difference in the AUCs between lactate and NLR among sepsis patients and among most of the subgroups. However, lactate outperformed NLR in the following subgroups: albumin<30 g/L, patients <65 years old and patients with sepsis due to a urinary tract infection. Our results advocate for the continued use of serum lactate rather than NLR, despite its limitations, as a predictor of mortality among septic patients and the different subgroups in this study.
长期以来，乳酸一直被认为是脓毒症的关键预后生物标志物。同样，中性粒细胞与淋巴细胞比值（NLR）在包括脓毒症在内的各种病症中的预后作用也已得到研究。既往研究探讨了区分脓毒症幸存者与非幸存者、预测菌血症、诊断脓毒症及评估死亡率的最佳NLR临界值。本研究比较了乳酸和NLR在脓毒症患者中的预后价值。
这项前瞻性队列研究纳入了2018年9月至2021年2月期间在一家三级医疗中心急诊科就诊的874例成年脓毒症或脓毒性休克患者。主要结局是比较NLR和乳酸对住院死亡率的预后价值。次要结局比较了它们在不同脓毒症亚组中的预后价值。
逐步逻辑回归显示，NLR与住院死亡率无关（OR=1.003，p=0.544），而乳酸与住院死亡率显著相关（OR=1.188，p<0.0001）。NLR和乳酸的曲线下面积（AUC）无显著差异（0.552对0.591，p=0.22）。在白蛋白<30的患者、年龄<65岁的患者以及尿路感染引起的脓毒症患者中，乳酸的表现优于NLR。在脓毒性休克患者、乳酸<2、乳酸≥2、糖尿病、恶性肿瘤、慢性肾脏病、其他感染源、白蛋白≥30且年龄≥65的患者中，乳酸和NLR的AUC无显著差异。
在本研究中，与住院死亡率相关的是乳酸而非NLR。脓毒症患者及大多数亚组中，乳酸和NLR的AUC无显著差异。然而，在以下亚组中乳酸的表现优于NLR：白蛋白<30 g/L、年龄<65岁的患者以及尿路感染引起的脓毒症患者。尽管血清乳酸有其局限性，但我们的结果支持继续将其而非NLR用作本研究中脓毒症患者及不同亚组死亡率的预测指标。
