Dynamic Clustering Analysis of Neutrophil to Lymphocyte Ratio Evolution Overtime in Intensive Care Unit Patients

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13-Feb-6315.2025
Published Feb 27, 2025
DOI: https://doi.org/10.18103/mra.v13i2.6315

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Main Article Content

Alejandra Restrepo
Hospices Civils de Lyon, Immunology Laboratory, Hôpital E. Herriot, Lyon France
Muzhda Haem Rahimi
Hospices Civils de Lyon, Immunology Laboratory, Hôpital E. Herriot, Lyon France; Université de Lyon, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression”, Université Claude Bernard Lyon_1, Lyon, France
Maxime Bodinier
Université de Lyon, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression”, Université Claude Bernard Lyon_1, Lyon, France; Open Innovation & Partnerships, bioMérieux S.A., Marcy l'Etoile, France
Morgane Gossez
Hospices Civils de Lyon, Immunology Laboratory, Hôpital E. Herriot, Lyon France; CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm U1111, Université Claude Bernard-Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
Anne-Claire Lukaszewicz
Université de Lyon, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression”, Université Claude Bernard Lyon_1, Lyon, France; Hospices Civils de Lyon, Anesthesiology and Critical Care Medicine department, Hôpital E. Herriot, Lyon, France
Thomas Rimmelé
Université de Lyon, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression”, Université Claude Bernard Lyon_1, Lyon, France; Hospices Civils de Lyon, Anesthesiology and Critical Care Medicine department, Hôpital E. Herriot, Lyon, France  
Fabienne Venet
Hospices Civils de Lyon, Immunology Laboratory, Hôpital E. Herriot, Lyon France; Université Claude Bernard-Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
Guillaume Monneret
Hospices Civils de Lyon, Immunology Laboratory, Hôpital E. Herriot, Lyon France; Université de Lyon, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression”, Université Claude Bernard Lyon_1, Lyon, France

Abstract

Elevated neutrophil to lymphocyte ratio (NLR) upon ICU admission has been reported to be associated with disease progression, severity, or mortality in critically ill patients. However, the overtime trajectories of NLR after admission and their association with other markers of intensive care units patients’ immuno-inflammatory status have not be evaluated so far. In a cohort of 353 critically ill patients (sepsis, trauma, major surgery), we evaluated the association between NLR trajectories and patients’ deterioration (mortality or occurrence of nosocomial infection) both by a conventional analysis at each time-point and through K-means clustering analysis.  Additionally, these trajectories were delineated alongside established markers of hyper-inflammation (e.g., IL-6) or immunosuppression (including HLA-DR expression on monocytes, proportion of immature neutrophils, and plasma IL-10 levels). The results showed that persistently elevated NLR values were associated with an increased risk of patient deterioration, as demonstrated in a multivariate analysis that included usual clinical confounders. Patients belonging to the persistently elevated NLR endotype simultaneously exhibited heightened inflammation and pronounced immunosuppression. In conclusion, by providing integrated information on both hyper-inflammation and immunosuppression, NLR measurement holds significant promise for monitoring the immune status of ICU patients. This straightforward and standardized marker could serve to assess immune organ failure in ICU and assist in guiding potential immunomodulation strategies.

Keywords: Neutrophil, lymphocyte, NLR, sepsis, mHLA-DR, immunosuppression

Article Details

How to Cite
RESTREPO, Alejandra et al. Dynamic Clustering Analysis of Neutrophil to Lymphocyte Ratio Evolution Overtime in Intensive Care Unit Patients. Medical Research Archives, [S.l.], v. 13, n. 2, feb. 2025. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/6315>. Date accessed: 16 mar. 2025. doi: https://doi.org/10.18103/mra.v13i2.6315.
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Issue
Vol 13 No 2 (2025): Vol.13 issue 2 February 2025
Section
Research Articles

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