The Admission Neutrophil-Lymphocyte Ratio (NLR) Predict Survival in Patients with Extensive Burns

Abstract Background Extensive burns is one of the most common clinical severe traumas, with a high annual death rate. Previous studies showed that the neutrophil to lymphocyte ratio (NLR) is a prognostic factor for some inflammatory diseases. However, until now, no study has evaluated the clinical prognostic value of NLR in extensively burned patients. The aim of this study was to investigate the prognostic value of NLR in this medical condition through the receiver operating characteristic (ROC) curve to provide a guidance for clinician. Methods 271 patients diagnosed with extensive burns were analysed retrospectively between 2005 and 2018 in the Department of Burn Surgery of Changhai Hospital. NLR cut-off values at the first 3 days of hospitalization were calculated by the ROC analysis. Results Of the 271 patients in this study, the majority of patients (82.3%) were hurt by flame. The median total body surface area (TBSA) was 55% (IQR, 40% to 85%) and the median full thickness burn (FTB) was 20% (IQR, 3%–44%). The patients’ NLR declined within the first 3 days after admission and we found that the NLR was negatively correlated with the ventilator-free days at day 28 (r = -0.127, P = 0.048). In the multivariate logistic regression analysis, higher admission NLR was independently predictive of higher mortality. According to the ROC curve, the best cut-off values for day 1 (or admission day), day 2 and day 3 NLR were 14, 13 and 7.5, respectively. We then performed a survival analysis, finding that patients with a NLR above the cut-off point had decreased OS compared to patient with NLR below the cut-off point (P = 0.023, 0.045 and 0.019 for day 1, 2, and 3, respectively). Conclusions NLR continuously decreased in the first 3 days of hospitalization. Admission NLR above 14 is associated with a decreased survival in patients with extensive burns. These findings showed that NLR was a good prognostic indication in these patients.