China: Neutrophils to lymphocytes and platelets ratio (N/LPR)- is a more accurate predictor of mortality rate in acute respiratory distress syndrome (ARDS) patients than neutrophil-to-lymphocyte ratio (NLR), a recent study has found. The study was published in the journal BMC Pulmonary Medicine on 15 August 2022.
Acute respiratory distress syndrome is a fatal respiratory failure disease that occurs often in critically ill patients. ARDS is associated with coagulation abnormalities and immune dysregulation, considering this, it becomes necessary to identify a predictor for accurate prediction of ARDS mortality based on its pathophysiology. '
Against the above background, Nian Wang, Chongqing Medical University, Chongqing, China, and colleagues aimed to evaluate the clinical value of neutrophils to lymphocytes and platelets ratio for predicting 28-day mortality in patients with ARDS.
For this purpose, the researchers retrospectively reviewed the medical records of ARDS patients from July 2018 to October 2021. Collection of lymphocyte count, neutrophil count, and platelet count was done, and N/LPR and NLR were calculated. The optimal cut-off values for 28-day mortality in ARDS were evaluated using the receiver operating characteristic (ROC) curve.
The researchers included a total of 136 ARDS patients and were divided further into survivors (n = 69) and non-survivors (n = 67) groups in accordance with their survival status on day 28.
Based on the study, the researchers found the following:
There were no significant differences between the two groups in age, sex, history of smoking and drinking, comorbidities, and reasons of admission.
Non-survivors had significantly higher neutrophil counts, NLR and N/LPR and had significantly lower platelet counts than survivors.
N/LPR, NLR and platelet counts were independent predictors for 28-day mortality in ARDS.
N/LPR with optimal cut-off value of 10.57 (sensitivity: 74.6%; specificity: 72.5%) is a more reliable predictor for 28-day mortality in ARDS than NLR and platelet count (AUC: 0.785 vs. 0.679 vs. 0.326).
Subgroup analysis confirmed that ARDS patients with N/LPR < 10.57 had significantly lower 28-day mortality than patients with N/LPR ≥ 10.57.
Kaplan–Meier analysis also confirmed that ARDS patients with N/LPR < 10.57 had significantly longer survival.
"N/LPR is an independent risk factor associated with 28-day mortality in ARDS patients and in addition, showed better performance in predicting mortality rate than NLR," the researchers wrote.
"N/LPR therefore, in clinical practice, should be considered as one of the routine indicators for monitoring and reporting the health status of ARDS patients which can provide judgment reference for physicians," they conclude.
Reference:
Nie, S., Wang, H., Liu, Q. et al. Prognostic value of neutrophils to lymphocytes and platelets ratio for 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study. BMC Pulm Med 22, 314 (2022). https://doi.org/10.1186/s12890-022-02112-w