The Value of Neutrophil-To-Lymphocyte Ratio for Evaluating Blood Stream Infection Caused by Carbapenem-Resistant Klebsiella pneumoniae : A Retrospective Cohort Study

• Published in: Frontiers in medicine 2022-03, Vol.9, p.832655-832655
• Main Authors: Wu, Heng, Mao, Yihan, Du, Xiaoxing, Zhao, Feng, Jiang, Yan, Yu, Yunsong
• Format: Article
• Language: English
• Subjects: blood stream infection; carbapenem-resistant Klebsiella pneumoniae; Medicine; neutrophil-to-lymphocyte ratio; prognosis; therapy strategies
• ISSN: 2296-858X; 2296-858X
• DOI: 10.3389/fmed.2022.832655

The neutrophil-to-lymphocyte ratio (NLR) is a useful marker of inflammation. However, the prognostic function of the NLR in patients with carbapenem-resistant (CRKP) blood stream infection (BSI) remains largely unknown. The aim of this study was to explore the potential relationship between the NLR and mortality in these patients. We performed a retrospective cohort study based on data retrieved from the computerized patient record system in a tertiary hospital from 1 January 2017 to 31 October, 2020. A total of 134 inpatients with CRKP BSI were enrolled in this study, including 54 fatal cases and 80 survival cases, 28 days after the onset of CRKP BSI. A logistic analysis was performed to assess the association between the NLR on the 4th day and 28-day mortality. Multivariate analyses were used to control for the confounders. The overall 28-day mortality rate of patients with a CRKP BSI episode was 40.3% (54/134). We conducted a multivariate analysis of the data of 134 patients and found that the NLR on the 4th day [odds ratio (OR) 1.148, 95% confidence interval (CI) 1.076-1.225, < 0.001] and antibiotic exposure before BSI onset (OR 3.847, 95% CI 1.322-11.196, = 0.013) were independent risk factors for 28-day mortality of patients with CRKP BSI, while appropriate initial therapy (AIT, OR 0.073, 95% CI 0.017-0.307, < 0.001) was an independent protective factor. Among patients treated with AITs, the Cox proportional hazards regression analysis revealed a significant difference in prognosis (p = 0.006) between the ceftazidime/avibactam contained (CAZ) group and non CAZ-AVI groups. After dividing the non CAZ-AVI group into the tigecycline (TGC), colistin (COL), and TGC + COL groups, there were no differences between the CAZ-AVI group and the TGC group ( = 0.093), but CAZ-AVI group showed lower 28-day mortality than COL ( = 0.002) and TGC + COL ( = 0.002) groups. Meanwhile, there was no difference in NLR on the 1st day ( = 0.958) of patients in different groups but significant difference in NLR on the 4th day ( = 0.047). The NLR on the 4th day is a readily available and independent prognostic biomarker for patients with CRKP BSI. This marker may have the potential for use in evaluating the efficacy of different anti-infection therapy strategies at an early stage.