The neutrophil lymphocyte ratio may predict the discharge status in patients admitted to the emergency department Neutrophil Lymphocyte Ratio in the Emergency Department
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Abstract
Objective: The neutrophil to lymphocyte ratio (NLR) has been investigated as an indicator of mortality and/or morbidity in many clinical pathologies. However, these studies have mostly been conducted for specific diseases. We investigated whether there is a relationship between the NLR and hospitalization or discharge decisions in the emergency department (ED).
Methods: We retrospectively reviewed the medical records of patients admitted to the ED. The NLR values of the patients were calculated, and their demographic characteristics (age and gender) and clinical outcomes were recorded.
Results: Of the 1970 patients, 1400 (71.1%) were discharged from the ED, and 570 (28.9%) were hospitalized. The patients who were discharged were younger and had lower NLR values, and this group had a lower female gender ratio (p<0.001, p<0.001, and p<0.001, respectively). The NLR threshold for discharge was 4.8, with a sensitivity of 70% and a specificity of 60%. Of the 570 hospitalized patients, 478 (83.9%) were discharged from the hospital and 92 (16.1%) died. Deceased patients were statistically significantly older with higher NLR values (p<0.001 and p=0.001, respectively). The threshold value of NLR for predicting mortality was calculated as 11.5, with a sensitivity of 45% and a specificity of 77%.
Conclusions: Our study reveals that the NLR is an important predictor of hospitalization and mortality in patients admitted to the ED regardless of diagnosis. ED physicians may consider to discharge patients with NLR values below 4.8 instead of spending additional time with advanced tests. In addition, clinicians should review the risk of mortality in patients with NLR values greater than 11.5 more thoroughly concerning mortality and should consider early aggressive treatment options.
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Accepted 2020-03-20
Published 2020-03-23
References
Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med. 2017;35(2):234-9.
Kurtipek E, Bekci T, Kesli R, Sami S, Terzi Y. The role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease. J Pak Med Assoc. 2015;65(12):1283-7.
Afari M, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an
update. Expert Rev Cardiovasc Ther. 2016;14(5):573-7.
Gökhan S, Ozhasenekler A, Mansur D, Akil E, Ustündag M, Orak M. Neutrophil lymphocyte
ratios in stroke subtypes and transient ischemic attack. Eur Rev Med Pharmacol Sci. 2013;17(5):653-7.
Kucuk A, Erol MF, Senel S, Eroler E, Yumun HA, Uslu AU, et al. The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis. Korean J Intern Med. 2016;31(2):386-91.
Zahorec R. Ratio of neutrophil to lymphocyte counts rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Med J. 2001;102(1): 5-14.
Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: an international issue. Intern Emerg Med. 2015;10:171.
Brabrand M, Folkestad L, Clausen NG, Knudsen T, Hallas J. Risk scoring systems for adults admitted to the emergency department: a systematic review. Scand J Trauma Resusc Emerg Med. 2010;18:8.
Froom P, Shimoni Z. Prediction of hospital mortality rates by admission laboratory tests. Clin Chem. 2006;18:325-8.
Perera YS, Ranasinghe P, Adikari AMMC, Welivita WD, Perera WME, Wijesundara WMDR, et al. The value of the Modified Early Warning Score and biochemical parameters as predictors of patient outcome in acute medical admissions a prospective study. Acute Med 2011;10:126-32.
Proctor MJ, McMillan DC, Horgan PG, Fletcher CD, Talwar D, Morrison DS. Systemic inflammation predicts all-cause mortality: A Glasgow inflammation outcome study. PLoS One. 2015;10(3).e0116206. doi:10.1371/journal pone.0116206
Akilli NB, Yortanli M, Mutlu H, Gunaydin YK, Koylu R, Akca HS, et al. Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes. Am J Emerg Med. 2014;32:1476-80.