Neutrophil-to-lymphocyte Ratio as a New Predictor of Sepsis in Critically-ill Stroke Patients

Vera Irawany; Marilaeta Cindryani Lolobali

doi:10.3889/oamjms.2022.9446

Authors

Vera Irawany Department of Anesthesiology and Intensive Care, Universitas Indonesia, Rumah Sakit Fatmawati, Jakarta, Indonesia
Marilaeta Cindryani Lolobali Department of Anesthesiology and Intensive Care, Universitas Indonesia, Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia https://orcid.org/0000-0001-8458-5760

DOI:

https://doi.org/10.3889/oamjms.2022.9446

Keywords:

Neutrophil-to-lymphocyte ratio, Predictor, sepsis, Acute stroke, Immunodepression

Abstract

BACKGROUND: Several studies have reported that many severe stroke patients developed sepsis during their acute phase, which leads to poor outcomes. In stroke, there is a shift from predominant Th1 lymphocytes, which have proinflammatory characteristics, to predominant Th2 lymphocytes which activate anti-inflammatory responses that induce hyporesponsiveness of the immune system against an invasion of pathogen, known as stroke-induced immunodepression syndrome.

AIM: This study aims to examine whether the neutrophils-to-lymphocytes ratio (NLR) could predict the development of sepsis in acute stroke patients.

METHODS: Patients were admitted to Fatmawati hospital intensive care unit from September 2019 to May 2020.

RESULTS: The mean NLR of acute stroke patients during their stay in ICU was 16.8 ± 12.5. We performed Mann–Whitney test, which revealed that the mean rank of several NLR parameters, such as initial NLR, day-3 NLR, highest NLR, and dNLR in stroke patients at ICU, was associated with the incidence of sepsis. The median difference in day-3 NLR, highest NLR, and dNLR in the stroke group with sepsis differed from those of the non-sepsis group.

CONCLUSION: NLR is assumed to have potential as an early predictor to distinguish septic conditions from non-septic conditions, to prevent delay in establishing diagnosis and management of sepsis, especially in acute, critically-ill stroke patients.

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References

Winkler MS, Rissiek A, Priefler M, Schwedhelm E, Robbe L, Bauer A, et al. Human leucocyte antigen (HLA-DR) gene expression is reduced in sepsis and correlates with impaired TNFα response: A diagnostic tool for immunosuppression? PLoS One. 2017;12(8):e0182427. https://doi.org/10.1371/journal.pone.0182427 PMid:28771573 DOI: https://doi.org/10.1371/journal.pone.0182427

Haeusler KG, Schmidt WU, Foehring F, Meisel C, Guenther C, Brunecker P, et al. Immune responses after acute ischemic stroke or myocardial infarction. Int J Cardiol. 2012;155(3):372-7. https://doi.org/10.1016/j.ijcard.2010.10.053 PMid:21078527 DOI: https://doi.org/10.1016/j.ijcard.2010.10.053

Liu DD, Chu SF, Chen C, Yang PF, Chen NH, He X, et al. Research progress in stroke-induced immunodepression syndrome (SIDS) and stroke-associated pneumonia (SAP). Neurochem Int. 2018;114:42-54. https://doi.org/10.1016/j.neuint.2018.01.002 PMid:29317279 DOI: https://doi.org/10.1016/j.neuint.2018.01.002

Faura J, Bustamante A, Miró-Mur F, Montaner J. Stroke-induced immunosuppression: implications for the prevention and prediction of post- stroke infections. J Neuroinflammation. 2021;18(1):127. https://doi.org/10.1186/s12974-021-02177-0 PMid:34092245 DOI: https://doi.org/10.1186/s12974-021-02177-0

Wu JF, Ma J, Chen J, Ou-Yang B, Chen MY, Li LF, et al. Changes of monocyte human leukocyte antigen-DR expression as a reliable predictor of mortality in severe sepsis. Crit Care. 2011;15(5):R220. https://doi.org/10.1186/cc10457 PMid:21933399 DOI: https://doi.org/10.1186/cc10457

Thursby E, Juge N. Introduction to the human gut microbiota. Biochem J. 2017;474(11):1823-36. https://doi.org/10.1042/BCJ20160510 PMid:28512250 DOI: https://doi.org/10.1042/BCJ20160510

Singh V, Roth S, Llovera G, Sadler R, Garzetti D, Stecher B, et al. Microbiota dysbiosis controls the neuroinflammatory response after stroke. J Neurosci. 2016;36(28):7428-40. https://doi.org/10.1523/JNEUROSCI.1114-16.2016 PMid:27413153 DOI: https://doi.org/10.1523/JNEUROSCI.1114-16.2016

Fay KT, Ford ML, Coopersmith CM. The intestinal microenvironment in sepsis. Biochim Biophys Acta Mol Basis Dis. 2017;1863(10):2574-83. https://doi.org/10.1016/j.bbadis.2017.03.005 PMid:28286161 DOI: https://doi.org/10.1016/j.bbadis.2017.03.005

Hooper LV, Littman DR, Macpherson AJ. Interactions between the microbiota and the immune system. Science. 2012;336(6086):1268-73. https://doi.org/10.1126/science.1223490 PMid:22674334 DOI: https://doi.org/10.1126/science.1223490

Hu Y, Zheng Y, Wu Y, Ni B, Shi S. Imbalance between IL-17A-producing cells and regulatory T cells during ischemic stroke. Mediators Inflamm. 2014;2014:813045. https://doi.org/10.1155/2014/813045 PMid:24991091 DOI: https://doi.org/10.1155/2014/813045