Neutrophil‑ and platelet‑to‑lymphocyte ratios in sepsis: mortality links in diabetic patients and hospital burden in acute kidney injury
File(s)
Author(s)
Abshori, Nuril Farid
Iqhrammullah, Muhammad
Mardliyyah, Raihan Radliyatul
Negara, R Moch Satrio Siliwangi Syariffatihmulia
Arif, Achmad Zainudin
Type
Journal Article
Abstract
Introduction: Timely identification of sepsis patients at elevated risk for in-hospital mortality or prolonged hospitalization remains a clinical imperative. This study assessed the prognostic utility of two readily available hematological biomarkers—the neutrophil-to-lymphocyte count ratio (NLCR) and platelet-to-lymphocyte count ratio (PLCR)—for their association with mortality and length of stay (LOS) among sepsis patients, including high-risk subgroups with acute kidney injury (AKI) or type 2 diabetes mellitus (T2DM).
Methodology: This retrospective 1-year cohort study included 202 adult sepsis patients. NLCR and PLCR were derived from admission complete blood counts. Receiver operating characteristic curve analysis was used to evaluate discriminative performance, with optimal thresholds determined using Youden’s index. Kaplan–Meier and log-rank tests assessed survival differences, while LOS comparisons were analyzed using Mann–Whitney and Chi-square tests.
Results: NLCR demonstrated limited overall prognostic value for mortality (AUC 0.560; sensitivity 53.68%; specificity 63.55%) but showed improved discrimination in patients with T2DM (AUC 0.603). PLCR was not associated with mortality in any subgroup (AUCs: 0.438–0.539). Diabetic patients with low NLCR had significantly higher survival (62.4% vs. 32.8%; p=0.039). No significant survival differences were observed in the overall or AKI cohorts. Both NLCR and PLCR had poor association with LOS (AUC<0.55). However, AKI patients with elevated NLCR had significantly prolonged hospitalization (11.5±4.9 vs. 7.83±4.5 days; p=0.039). PLCR was not significantly associated with LOS.
Conclusions: NLCR may provide modest, preliminary prognostic value in specific sepsis subgroups, particularly those with T2DM or AKI, and may serve as a low cost adjunct for early risk stratification.
Methodology: This retrospective 1-year cohort study included 202 adult sepsis patients. NLCR and PLCR were derived from admission complete blood counts. Receiver operating characteristic curve analysis was used to evaluate discriminative performance, with optimal thresholds determined using Youden’s index. Kaplan–Meier and log-rank tests assessed survival differences, while LOS comparisons were analyzed using Mann–Whitney and Chi-square tests.
Results: NLCR demonstrated limited overall prognostic value for mortality (AUC 0.560; sensitivity 53.68%; specificity 63.55%) but showed improved discrimination in patients with T2DM (AUC 0.603). PLCR was not associated with mortality in any subgroup (AUCs: 0.438–0.539). Diabetic patients with low NLCR had significantly higher survival (62.4% vs. 32.8%; p=0.039). No significant survival differences were observed in the overall or AKI cohorts. Both NLCR and PLCR had poor association with LOS (AUC<0.55). However, AKI patients with elevated NLCR had significantly prolonged hospitalization (11.5±4.9 vs. 7.83±4.5 days; p=0.039). PLCR was not significantly associated with LOS.
Conclusions: NLCR may provide modest, preliminary prognostic value in specific sepsis subgroups, particularly those with T2DM or AKI, and may serve as a low cost adjunct for early risk stratification.
Editor(s)
Fanelli, Chiara
Date Issued
2026-06-01
Date Acceptance
2025-11-17
Citation
The Journal of Infection in Developing Countries, 2026, 20, pp.854-863
ISSN
1972-2680
Publisher
JIDC
Start Page
854
End Page
863
Journal / Book Title
The Journal of Infection in Developing Countries
Volume
20
Copyright Statement
Copyright © 2026 Abshori et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
License URL
Identifier
10.3855/jidc.22254
Subjects
sepsis
acute kidney injury
diabetes mellitus
neutrophil-to-lymphocyte ratio
platelet count
Publication Status
Published
Coverage Spatial
United Kingdom
Article Number
22254