Article Sidebar

Submitted
29 October 2021
Accepted
8 April 2022
Published
5 June 2022
Download
PDF
Statistic
Read Counter : 487 Download : 292

Main Article Content

Abstract

Highlights:



  1. The combination of NLCR and PLR will improve the ability to distinguish infection rather than noninfection in the emergency setting for early antibiotic prescribing as well as the sepsis-3 strategy.

  2. The diagnostic value of PLR in adult bacterial sepsis patients has never been studied.


 

Abstract:


According to Sepsis-3, antibiotics should be administered in the first hour of diagnosis of sepsis. Still, there is difficulty in differentiating between bacterial and nonbacterial infections and a lack of a rapid diagnostic tool to distinguish them. This study evaluated the diagnostic value of NLCR and PLR in suspected bacterial sepsis. The diagnostic value of PLR in adult bacterial sepsis patients has never been studied. This study was a retrospective study from the medical record of Dr. Hasan Sadikin Hospital Bandung. All patients at age ≥ 18 years diagnosed with sepsis based on ICD-10 code and qSOFA ≥ 2 were included. We calculated sensitivity, specificity, NPV, PPV, positive LR, and AUC of NLCR and PLR. There were 177 patients included in this study. The sensitivity of NLCR was 69.5%, specificity was 34.7%, NPV was 56.9%, PPV was 47.9%, and LR+ was 1.06, while the sensitivity of PLR was 62.2%, specificity was 38.9%, NPV was 54.4%, PPV was 46.8%, and LR+ was 1.02. We obtained cut-off values for NLCR 11.06, AUC 0.500, PLR 222.41, and AUC 0.497. The low value of AUC NLCR and PLR was due to prior antibiotic use. The combination of NLCR and PLR had higher positive LR (1.16) and specificity (54.7%), and also, according to NLCR, we had the highest sensitivity (69.5%). The combination of NLCR and PLR enhances the sepsis-3 strategy because it can be used as screening tools for bacterial sepsis, and antibiotics can also be administered in the first hour of managing sepsis, particularly in the emergency ward.

Keywords

Bacterial sepsis diagnostic value infectious disease NLCR PLR

Article Details

License

Copyright (c) 2022 Folia Medica Indonesiana

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

  • Folia Medica Indonesiana is a scientific peer-reviewed article which freely available to be accessed, downloaded, and used for research purposes. Folia Medica Indonesiana (p-ISSN: 2541-1012; e-ISSN: 2528-2018) is licensed under a Creative Commons Attribution 4.0 International License. Manuscripts submitted to Folia Medica Indonesiana are published under the terms of the Creative Commons License. The terms of the license are:

    Attribution ” You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

    NonCommercial ” You may not use the material for commercial purposes.

    ShareAlike ” If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.

    No additional restrictions ” You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

    You  are free to :

    Share ” copy and redistribute the material in any medium or format.

    Adapt ” remix, transform, and build upon the material.

How to Cite
Pranggono, E. H., Aini, E. N., Sumardi, U., Hartranti, Y., & Sugianli, A. K. (2022). The Combination of NLCR and Enhances the Sepsis-3 Strategy. Folia Medica Indonesiana, 58(2), 122–128. https://doi.org/10.20473/fmi.v58i2.31051
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX

References

  1. Abe T, Kushimoto S, Tokuda Y, et al (2019). Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: A descriptive analysis of a prospective observational study. Crit. Care 23, 1–11.
  2. Arcagok B, Karabulut B (2019). Platelet to lymphocyte ratio in neonates: A predictor of early onset neonatal sepsis. Mediteranian J. Hematol. Infect. Dis. 11, 1–8.
  3. Bartlett J, Breiman R, Mandell L, et al (1998). Community-acquired pneumonia in adults: Guidelines for management. Clin. Infect. Dis. 26, 811–838.
  4. Can E, Hamilcikan S, Can C (2018). The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio for detecting early-onset neonatal sepsis. J. Pediatr. Hematol. Oncol. 40, 229–232.
  5. Davis B (2005). Improved diagnostic approaches to infection/sepsis detection. Expert Rev. Mol. Diagn. 5, 193–207.
  6. de Jager C, van Wijk P, Mathoera R, et al (2010). Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit. Care 14, 1–8.
  7. Dellinger R, Levy M, Rhodes A, et al (2013). Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit. Care Med. 41, 580–637.
  8. Hall M, Williams S, DeFrances C, et al (2011). Inpatient care for septicemia or sepsis: A challenge for patients and hospitals. NCHS Data Brief 62, 1–8.
  9. Kumar G, Kumar N, Taneja A, et al (2011). Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest 140, 1223–1231.
  10. Lehman K (2019). Surviving Sepsis Campaign recommends Hour-1 bundle use. Nurse Pract. 44, 10.
  11. Ljungström L, Pernestig A, Jacobsson G, et al (2017). Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PLoS One 12, 1–17.
  12. Luhulima D, Marwito M, Eva O (2017). Neutrophil-lymphocyte count ratio in bacterial sepsis (rasio neutrofil-limfosit pada sepsis bakterial). Indones. J. Clin. Pathol. Med. Lab. 23, 257–262.
  13. Madison J, Irwin R (2004). Expectorated sputum for community-acquired pneumonia: A sacred cow. Arch. Intern. Med. 164, 1725–1727.
  14. Mandal R, Valenzuela P (2018). Lymphocyte count ratio on admission as a predictor of bacteremia and in hospital mortality among sepsis and septic shock in patients at Rizal Medical Center. Asian J. Med. Sci. 9, 36–40.
  15. Marik P, Stephenson E (2020). The ability of Procalcitonin, lactate, white blood cell count and neutrophil-lymphocyte count ratio to predict blood stream infection. Analysis of a large database. J. Crit. Care 60, 135–139.
  16. Purba A, Mariana N, Aliska G, et al (2020). The burden and costs of sepsis and reimbursement of its treatment in a developing country: An observational study on focal infections in Indonesia. Int. J. Infect. Dis. 96, 211–218.
  17. Scheer C, Fuchs C, Gründling M, et al (2019). Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: A prospective clinical cohort study. Clin. Microbiol. Infect. 25, 326–331.
  18. Shen Y, Huang X, Zhang W (2019). Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: Interaction effect with disease severity-a retrospective study. BMJ Open 9, 1–7.
  19. Singer M, Deutschman C, Seymour C, et al (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315, 801–810.
  20. Visveswari G, Min B, Lateef F (2019). Diagnostic value of biomarkers for sepsis in adult patients in the emergency department: Don't forget the neutrophil-lymphocyte count ratio. J. Acute Dis. 8, 45–52.
  21. Weinstein M (2003). Blood culture contamination: persisting problems and partial progress. J. Clin. Microbiol. 41, 2275–2278.
  22. Westerdijk K, Simons K, Zegers M, et al (2019). The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study. PLoS One 14, 1–13.
  23. Zhang H, Chen J, Lan Q, et al (2016). Diagnostic values of red cell distribution width, platelet distribution width and neutrophil"‘lymphocyte count ratio for sepsis. Exp. Ther. Med. 12, 2215–2219.