Elevated neutrophil to lymphocyte ratio predicts mortality in medical inpatients with multiple chronic conditions
Journal
Medicine
Journal Volume
95
Journal Issue
23
Date Issued
2016-06
Author(s)
Abstract
Neutrophil to lymphocyte ratio (NLR) is an easy measurable laboratory marker used to evaluate systemic inflammation. Elevated NLR is associated with poor survival and increased morbidity in cancer and cardiovascular disease. However, the usefulness of NLR to predict morbidity and mortality in a hospital setting for patients with multiple chronic conditions has not been previously examined. In this study, we investigate the association between NLR and mortality in multimorbid medical inpatients. Two hundred thirty medical in-patients with chronic conditions were selected from a single academic medical center in Taiwan. Retrospective NLRs were calculated from routine full blood counts previously obtained during the initial hospital admission and at the time of discharge. Self-rated health (using a single-item question), medical disorders, depressive symptoms, and medical service utilization over a 1-year period were included in the analyses. Mortality outcomes were ascertained by reviewing electronic medical records and follow-up. The mortality rate at 2-year follow-up was 23%. Depression (odds ratio [OR] 1.9 [95% CI 1.0-3.7]), poor self-rated health (OR 2.1 [95% CI 1.1-3.9]), being hospitalized 2 or more times in the previous year (OR 2.3 [95% CI 1.2-4.6]), metastatic cancer (OR 4.7 [95% CI 2.3-9.7]), and chronic liver disease (OR 4.3 [95% CI 1.5-12.1]) were associated with 2-year mortality. The median (interquartile range) NLR at admission and discharge were 4.47 (2.4-8.7) and 3.65 (2.1-6.5), respectively. Two-year mortality rates were higher in patients with an elevated NLR at admission (NLR <3 = 15.5%, NLR >3 = 27.6%) and discharge (NLR < 3 = 14.7%, NLR >3 = 29.1%). Multivariate logistic regression demonstrated that an elevated NLR >3.0 at admission (OR 2.3 [95% CI 1.0-5.2]) and discharge (OR 2.3 [95% CI 1.1-5.0]) were associated with mortality independent of baseline age, sex, education, metastatic cancer, liver disease, depression, and previous hospitalization. Increased NLR is associated with mortality among medical inpatients with multiple chronic conditions. NLR may provide added value to predict both risk of mortality for the inpatients with chronic conditions, in addition to allowing predictions of likely hospital service needs such as re-admissions that are associated with long-term mortality.
Subjects
chronic conditions; medical service use; mortality; neutrophil-lymphocyte ratio; CANCER-PATIENTS; PREOPERATIVE NEUTROPHIL; CLINICAL-TRIALS; GASTRIC-CANCER; INFLAMMATION; VALIDATION; DISCHARGE; RESECTION; FAILURE; TAIWAN
Other Subjects
adult; Article; blood cell count; blood sampling; chronic liver disease; depression; educational status; electronic medical record; female; follow up; health care utilization; hospital admission; hospital discharge; hospital patient; hospitalization; human; major clinical study; male; medical service; metastasis; mortality; mortality rate; neutrophil lymphocyte ratio; prediction; priority journal; retrospective study; suicidal ideation; treatment duration; cause of death; hospital patient; leukocyte count; lymphocyte; middle aged; multiple chronic conditions; neutrophil; pathology; survival rate; Taiwan; trends; Cause of Death; Female; Follow-Up Studies; Humans; Inpatients; Leukocyte Count; Lymphocytes; Male; Middle Aged; Multiple Chronic Conditions; Neutrophils; Retrospective Studies; Survival Rate; Taiwan
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Type
journal article