The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis 
Who Underwent Hemoperfusion in General 
Intensive Care Unit

The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit

Öz:

Objective: Sepsis is a major cause of mortality and morbidity in the intensive care units. The goal of this study is to investigate whether changes in the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are a prognostic marker for patients with sepsis (according to sepsis stages, and patient’s and disease’s characteristics) who have been followed up in the intensive care unit and who have received HA330 resin-directed hemadsorption column for sepsis. Methods: The study included a group of 100 (male [healed: 19, exitus: 42], female [cured: 29, exitus: 10]) sepsis patients who were followed up in the intensive care unit between December 2019 and December 2021 and who received HA-330 sepsis adsorption column. Results: Although a strong positive correlation was found between the neutrophil-to-lymphocyte ratio and the baseline platelet-to-lymphocyte ratio values (r=0.725 and P = .001), a weak positive correlation was found between the baseline neutrophil-to-lymphocyte ratio and the comorbidity values (r = 0.253 and P=.001). In addition, the period found for hemoperfusion in those who healed was statistically significantly higher in exitus patients (P=.001). It was noted that the improvement in repeated neutrophil-to-lymphocyte ratio measurements in the healing and death observations was identical (P > .05). The repeated neutrophil-to-lymphocyte ratio measurement values were found to be statistically significantly different for those with healing (P=.014). In addition, repeated neutrophil-to-lymphocyte ratio measurement values were found to be statistically significantly different from those with exitus (P=.001). It was observed that the change of repeated platelet-to-lymphocyte ratio measurements in the observations with healing and death was statistically significant (P < .05). Conclusion: It is thought that it may be a cheap and useful biomarker in the prognosis of patients who are followed up in the intensive care unit and are treated with HA-330 sepsis adsorption column since the rate of neutrophils and lymphocytes in patients with hematological healing and death differs greatly.

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1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810. [CrossRef]
2. Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):775-787. [CrossRef]
3. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. [CrossRef]
4. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304-377. [CrossRef]
5. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644-1655. [CrossRef]
6. Levy MM, Fink MP, Marshall JC, et al. 2001 sccm/esicm/accp/ats/sis international sepsis definitions conference. Intensive Care Med. 2003;29(4):530-538. [CrossRef]
7. Reinhart K, Daniels R, Kissoon N, Machado FR, Schachter RD, Finfer S. Recognizing sepsis as a global health priority - a WHO resolution. N Engl J Med. 2017;377(5):414-417. [CrossRef]
8. Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312(1):90-92. [CrossRef]
9. Burrell AR, McLaws ML, Fullick M, Sullivan RB, Sindhusake D. SEPSIS KILLS: early intervention saves lives. Med J Aust. 2016;204(2):73. [CrossRef]
10. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486-552. [CrossRef]
11. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589- 1596. [CrossRef]
12. Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376(23):2235-2244. [CrossRef]
13. Shum HP, Yan WW, Chan TM. Extracorporeal blood purification for sepsis. Hong Kong Med J. 2016;22(5):478-485. [CrossRef]
14. Rimmelé T, Kellum JA. Clinical review: blood purification for sepsis. Crit Care. 2011;15(1):205. [CrossRef]
15. Gullo A, Bianco N, Berlot G. Management of severe sepsis and septic shock: challenges and recommendations. Crit Care Clin. 2006;22(3):489-501, ix. [CrossRef]
16. Cole L, Bellomo R, Journois D, Davenport P, Baldwin I, Tipping P. High-volume haemofiltration in human septic shock. Intensive Care Med. 2001;27(6):978-986. [CrossRef]
17. Atan R, Crosbie D, Bellomo R. Techniques of extracorporeal cytokine removal: a systematic review of the literature. Blood Purif. 2012;33(1- 3):88-100. [CrossRef]
18. Formica M, Inguaggiato P, Bainotti S, Wratten ML. Coupled plasma filtration adsorption. Contrib Nephrol. 2007;156:405-410. [CrossRef]
19. Marshall JC, Reinhart K, International Sepsis Forum. Biomarkers of sepsis. Crit Care Med. 2009;37(7):2290-2298. [CrossRef]
20. Joshi VD, Kalvakolanu DV, Cross AS. Simultaneous activation of apoptosis and inflammation in pathogenesis of septic shock: a hypothesis. FEBS Lett. 2003;555(2):180-184. [CrossRef]
21. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102(6):653-657. [CrossRef]
22. Turkmen K, Erdur FM, Ozcicek F, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17(3):391- 396. [CrossRef]
23. Cohen IL. Definitions for sepsis and organ failure: the ACCP/SCCM Consensus Conference Committee report. Chest. 1993;103(2):656. [CrossRef]
24. Esmaeili Vardanjani A, Ronco C, Rafiei H, Golitaleb M, Pishvaei MH, Mohammadi M. Early hemoperfusion for cytokine removal may contribute to prevention of intubation in patients infected with COVID-19. Blood Purif. 2021;50(2):257-260. [CrossRef]
25. Chen YC, Tian YC, Liu NJ, et al. Prospective cohort study comparing sequential organ failure assessment and acute physiology, age, chronic health evaluation III scoring systems for hospital mortality prediction in critically ill cirrhotic patients. Int J Clin Pract. 2006;60(2):160-166. [CrossRef]
26. Schroeder SA, Sandy LG. Specialty distribution of US physicians – the invisible driver of health care costs. N Engl J Med;1193(328): 961-963.
27. Szalados JE. Intensive care unit resource utilization by medicare patients: magrin and mission meet public policy and practice economics. Crit Care Med. 2004;32(11):2351-2352. [CrossRef]
28. Ho YP, Chen YC, Yang C, et al. Outcome prediction for critically ill cirrhotic patients: a comparison of Apache II and Child-Pugh scoring systems. J Intensive Care Med. 2004;19(2):105-110. [CrossRef]
29. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39(2):206-217. [CrossRef]
30. Huang Z, Wang SR, Su W, Liu JY. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial. 2010;14(6):596- 602. [CrossRef]
31. Tang Y, Zhang L, Fu P, Kang Y, Liu F. Hemoperfusion plus continuous veno-venous hemofiltration in a pregnant woman with severe acute pancreatitis: a case report. Int Urol Nephrol. 2012;44(3):987- 990. [CrossRef]
32. Chu L, Li G, Yu Y, Bao X, Wei H, Hu M. Clinical effects of hemoperfusion combined with pulse high-volume hemofiltration on septic shock. Med (Baltim). 2020;99(9):e19058. [CrossRef]
33. Sprung CL, Sakr Y, Vincent JL, et al. An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence In Acutely Ill Patients (SOAP) study. Intensive Care Med. 2006;32(3):421- 427. [CrossRef]
34. Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301-1311. [CrossRef]
35. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372(17):1629-1638. [CrossRef]
36. Guirgis FW, Puskarich MA, Smotherman C, et al. Development of a simple sequential organ failure assessment score for risk assessment of emergency department patients with sepsis. J Intensive Care Med. 2020;35(3):270-278. [CrossRef]
37. Milbrandt EB, Eldadah B, Nayfield S, Hadley E, Angus DC. Toward an integrated research agenda for critical illness in aging. Am J Respir Crit Care Med. 2010;182(8):995-1003. [CrossRef]
38. Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM. Population burden of long-term survivorship after severe sepsis in older Americans. J Am Geriatr Soc. 2012;60(6):1070-1077. [CrossRef]
39. Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection. 2017;45(3):299- 307. [CrossRef]
40. Salciccioli JD, Marshall DC, Pimentel MA, et al. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care. 2015;19:13. [CrossRef]
41. Gürol G, Çiftci İH, Terizi HA, Atasoy AR, Ozbek A, Köroğlu M. Are there standardized cutoff values for neutrophil-lymphocyte ratios in bacteremia or sepsis? J Microbiol Biotechnol. 2015;25(4):521-525. [CrossRef]
42. Lorente L, Martín MM, Ortiz-López R, et al. Association between neutrophil-to-lymphocyte ratio in the first seven days of sepsis and mortality. Enferm Infecc Microbiol Clin (Engl Ed). 2020:S0213-005X(20)30405-5. doi: 10.1016/j.eimc.2020.11.004. [CrossRef]
43. Duman A, Akoz A, Kapci M, et al. Prognostic value of neglected biomarker in sepsis patients with the old and new criteria: predictive role of lactate dehydrogenase. Am J Emerg Med. 2016;34(11):2167- 2171. [CrossRef]
44. Zencir C, Akpek M, Senol S, et al. Association between hematologic parameters and in-hospital mortality in patients with infective endocarditis. Kaohsiung J Med Sci. 2015;31(12):632-638. [CrossRef]
45. Oh GH, Chung SP, Park YS, et al. Mean platelet volume to platelet count ratio as a promising predictor of early mortality in severe sepsis. Shock. 2017;47(3):323-330. [CrossRef]
46. Zheng CF, Liu WY, Zeng FF, et al. Prognostic value of platelet-tolymphocyte ratios among critically ill patients with acute kidney injury. Crit Care. 2017;21(1):238. [CrossRef]
47. Afyon M. Platelet-to-lymphocyte ratio as a cost-effective and easily measurable marker. Cukurova Med. 2016;41:610-611.

APA	Koc S, Dokur M, ÖZER T, KÜÇÜKCERİT T, karaoğuz b, CELEP Y, Aktepe E, Kaptanoğulları H, Karadağ M, Dizmen H, Tulum B, kuas e, ILERI A, Dokur S (2022). The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. , 37 - 44. 10.54614/eurjther.2022.0060
Chicago	Koc Suna,Dokur Mehmet,ÖZER Türkan,KÜÇÜKCERİT TANER ŞERİF,karaoğuz burcu,CELEP Yunus Emre,Aktepe Emre,Kaptanoğulları Hakan,Karadağ Mehmet,Dizmen Hacer,Tulum Betül,kuas elif,ILERI ASLIHAN,Dokur Sema Nur The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. (2022): 37 - 44. 10.54614/eurjther.2022.0060
MLA	Koc Suna,Dokur Mehmet,ÖZER Türkan,KÜÇÜKCERİT TANER ŞERİF,karaoğuz burcu,CELEP Yunus Emre,Aktepe Emre,Kaptanoğulları Hakan,Karadağ Mehmet,Dizmen Hacer,Tulum Betül,kuas elif,ILERI ASLIHAN,Dokur Sema Nur The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. , 2022, ss.37 - 44. 10.54614/eurjther.2022.0060
AMA	Koc S,Dokur M,ÖZER T,KÜÇÜKCERİT T,karaoğuz b,CELEP Y,Aktepe E,Kaptanoğulları H,Karadağ M,Dizmen H,Tulum B,kuas e,ILERI A,Dokur S The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. . 2022; 37 - 44. 10.54614/eurjther.2022.0060
Vancouver	Koc S,Dokur M,ÖZER T,KÜÇÜKCERİT T,karaoğuz b,CELEP Y,Aktepe E,Kaptanoğulları H,Karadağ M,Dizmen H,Tulum B,kuas e,ILERI A,Dokur S The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. . 2022; 37 - 44. 10.54614/eurjther.2022.0060
IEEE	Koc S,Dokur M,ÖZER T,KÜÇÜKCERİT T,karaoğuz b,CELEP Y,Aktepe E,Kaptanoğulları H,Karadağ M,Dizmen H,Tulum B,kuas e,ILERI A,Dokur S "The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit." , ss.37 - 44, 2022. 10.54614/eurjther.2022.0060
ISNAD	Koc, Suna vd. "The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit". (2022), 37-44. https://doi.org/10.54614/eurjther.2022.0060

APA	Koc S, Dokur M, ÖZER T, KÜÇÜKCERİT T, karaoğuz b, CELEP Y, Aktepe E, Kaptanoğulları H, Karadağ M, Dizmen H, Tulum B, kuas e, ILERI A, Dokur S (2022). The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. European Journal of Therapeutics, 28(1), 37 - 44. 10.54614/eurjther.2022.0060
Chicago	Koc Suna,Dokur Mehmet,ÖZER Türkan,KÜÇÜKCERİT TANER ŞERİF,karaoğuz burcu,CELEP Yunus Emre,Aktepe Emre,Kaptanoğulları Hakan,Karadağ Mehmet,Dizmen Hacer,Tulum Betül,kuas elif,ILERI ASLIHAN,Dokur Sema Nur The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. European Journal of Therapeutics 28, no.1 (2022): 37 - 44. 10.54614/eurjther.2022.0060
MLA	Koc Suna,Dokur Mehmet,ÖZER Türkan,KÜÇÜKCERİT TANER ŞERİF,karaoğuz burcu,CELEP Yunus Emre,Aktepe Emre,Kaptanoğulları Hakan,Karadağ Mehmet,Dizmen Hacer,Tulum Betül,kuas elif,ILERI ASLIHAN,Dokur Sema Nur The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. European Journal of Therapeutics, vol.28, no.1, 2022, ss.37 - 44. 10.54614/eurjther.2022.0060
AMA	Koc S,Dokur M,ÖZER T,KÜÇÜKCERİT T,karaoğuz b,CELEP Y,Aktepe E,Kaptanoğulları H,Karadağ M,Dizmen H,Tulum B,kuas e,ILERI A,Dokur S The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. European Journal of Therapeutics. 2022; 28(1): 37 - 44. 10.54614/eurjther.2022.0060
Vancouver	Koc S,Dokur M,ÖZER T,KÜÇÜKCERİT T,karaoğuz b,CELEP Y,Aktepe E,Kaptanoğulları H,Karadağ M,Dizmen H,Tulum B,kuas e,ILERI A,Dokur S The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit. European Journal of Therapeutics. 2022; 28(1): 37 - 44. 10.54614/eurjther.2022.0060
IEEE	Koc S,Dokur M,ÖZER T,KÜÇÜKCERİT T,karaoğuz b,CELEP Y,Aktepe E,Kaptanoğulları H,Karadağ M,Dizmen H,Tulum B,kuas e,ILERI A,Dokur S "The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit." European Journal of Therapeutics, 28, ss.37 - 44, 2022. 10.54614/eurjther.2022.0060
ISNAD	Koc, Suna vd. "The Prognostic Importance of Neutrophil-toLymphocyte Ratio and Platelet-toLymphocyte Ratio in Adult Patients with Sepsis Who Underwent Hemoperfusion in General Intensive Care Unit". European Journal of Therapeutics 28/1 (2022), 37-44. https://doi.org/10.54614/eurjther.2022.0060