The predictive value of monocyte-lymphocyte ratio for mortality in intensive care unit patients: a cohort study_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

FENG Xilian ¹ , ZHANG Wei ¹ ,  YANG Liuliu ¹

1. The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P. R. China;
2. The Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P. R., China;

Corresponding author：

YANG Liuliu, Email: liugzucm123@163.com

Keywords：

Monocyte-lymphocyte ratio; prediction; intensive care unit; mortality

DOI：

10.7507/1671-6205.202104005

Video：

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Objective To investigate the correlation between monocyte-lymphocyte ratio (MLR) and intensive care unit (ICU) results in ICU hospitalized patients. Methods Clinical data were extracted from Medical Information Mart for Intensive Care Ⅲ database, which contained health data of more than 50000 patients. The main result was 30-day mortality, and the secondary result was 90-day mortality. The Cox proportional hazards model was used to reveal the association between MLR and ICU results. Multivariable analyses were used to control for confounders. Results A total of 7295 ICU patients were included. For the 30-day mortality, the hazard ratio (HR) and 95% confidence interval (CI) of the second (0.23≤MLR<0.47) and the third (MLR≥0.47) groups were 1.28 (1.01, 1.61) and 2.70 (2.20, 3.31), respectively, compared to the first group (MLR<0.23). The HR and 95%CI of the third group were still significant after being adjusted by the two different models [2.26 (1.84, 2.77), adjusted by model 1; 2.05 (1.67, 2.52), adjusted by model 2]. A similar trend was observed in the 90-day mortality. Patients with a history of coronary and stroke of the third group had a significant higher 30-day mortality risk [HR and 95%CI were 3.28 (1.99, 5.40) and 3.20 (1.56, 6.56), respectively]. Conclusion MLR is a promising clinical biomarker, which has certain predictive value for the 30-day and 90-day mortality of patients in ICU.

Citation： FENG Xilian, ZHANG Wei, YANG Liuliu. The predictive value of monocyte-lymphocyte ratio for mortality in intensive care unit patients: a cohort study. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(2): 96-101. doi: 10.7507/1671-6205.202104005 Copy

1.	Wen YQ, Zhan XJ, Wang NS, et al. Monocyte/lymphocyte ratio and cardiovascular disease mortality in peritoneal dialysis patients. Mediators Inflamm, 2020, 2020: 9852507.
2.	Cai JJ, Wang K, Han T, et al. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Medicine, 2018, 97(46): 13-24.
3.	Gijsberts CM, Ellenbroek G, Ten Berg MJ, et al. Effect of monocyte-to-lymphocyte ratio on heart failure characteristics and hospitalizations in a coronary angiography cohort. Am J Cardiol, 2017, 120(6): 911-916.
4.	Xiang FF, Zhu JM, Cao XS, et al. Lymphocyte depletion and subset alteration correlate to renal function in chronic kidney disease patients. Renal Failure, 2016, 38(1): 7-14.
5.	Liu HL, Zhan F, Wang YZ. Evaluation of monocyte-to-high-density lipoprotein cholesterol ratio and monocyte-to-lymphocyte ratio in ischemic stroke. J Int Med Res, 2020, 48(7): 300060520933806.
6.	Cananzi F, Minerva EM, Samà L, et al. Preoperative monocyte-to-lymphocyte ratio predicts recurrence in gastrointestinal stromal tumors. J Surg Oncol, 2019, 119(1): 12-20.
7.	Kimyon Cömert G, Türkmen O, Kar İ, et al. Independent predictors of survival in endometrium cancer: platelet-to-lymphocyte ratio and platelet/neutrophil/monocyte-to-lymphocyte ratio. J Turk Ger Gynecol Assoc, 2018, 19(2): 78-86.
8.	Choi YH, Lee JW, Lee SH, et al. A high monocyte-to-lymphocyte ratio predicts poor prognosis in patients with advanced gallbladder cancer receiving chemotherapy. Cancer Epidemiol Biomarkers Prev, 2019, 28(6): 1045-1051.
9.	Johnson AE, Pollard TJ, Shen L, et al. MIMIC-Ⅲ, a freely accessible critical care database. Sci Data, 2016, 3: 160035.
10.	Chen QG, Zhang LS, Ge SH, et al. Prognosis predictive value of the Oxford Acute Severity of Illness Score for sepsis: a retrospective cohort study. PeerJ, 2019, 7: e7083.
11.	Chen QC, Huang K, Li LL, et al. Serum uric acid on admission cannot predict long-term outcome of critically ill patients: a retrospective cohort study. Ther Clin Risk Manag, 2018, 14: 1347-1359.
12.	Naess A, Nilssen SS, Mo R, et al. 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.
13.	Wang JL, Lu XY, Xu XH, et al. Predictive role of monocyte-to-lymphocyte ratio in patients with Klebsiella pneumonia infection: a single-center experience. Medicine, 2019, 98(38): e17215.
14.	Liu L, Wei Y, Wei X. The immune function of Ly6 Chi inflammatory monocytes during infection and inflammation. Curr Mol Med, 2017, 17(1): 4-12.
15.	Bieber K, Autenrieth SE. Insights how monocytes and dendritic cells contribute and regulate immune defense against microbial pathogens. Immunobiology, 2015, 220(2): 215-226.
16.	Tsuchimoto Y, Asai A, Tsuda Y, et al. M2b monocytes provoke bacterial pneumonia and gut bacteria-associated sepsis in alcoholics. J Immunol, 2015, 195(11): 5169-5177.
17.	Liu YL, Zheng J, Zhang DS, et al. Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis. J Clin Lab Anal, 2019, 33(7): e22942.
18.	Bosello O, Donataccio MP, Cuzzolaro M, et al. Obesity or obesities? Controversies on the association between body mass index and premature mortality. Eat Weight Disord, 2016, 21(2): 165-174.
19.	Fleischmann E, Teal N, Dudley J, et al. Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int, 1999, 55(4): 1560-1567.
20.	Kalantar-Zadeh K, Streja E, Kovesdy CP, et al. The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis. Mayo Clin Proc, 2010, 85(11): 991-1001.
21.	Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes, 2009, 33(3): 289-295.
22.	Kuk JL, Ardern CI, Church TS, et al. Edmonton Obesity Staging System: association with weight history and mortality risk. Appl Physiol Nutr Metab, 2011, 36(4): 570-576.
23.	Chiappetta S, Sharma AM, Bottino V, et al. COVID-19 and the role of chronic inflammation in patients with obesity. Int J Obes, 2020, 44(8): 1790-1792.
24.	Taşkın A, Can E, Hamilçıkan Ş, et al. Suspected or proven early-onset sepsis and NLR, PLR, and MPV parameters in neonates with born through MSAF[J/OL]. Am J Perinatol. (2020-10-08) https://dx.doi.org/10.1055/s-0040-1718369.
25.	Chung H, Lee JH, Jo YH, et al. Circulating monocyte counts and its impact on outcomes in patients with severe sepsis including septic shock. Shock, 2019, 51(4): 423-429.

1. Wen YQ, Zhan XJ, Wang NS, et al. Monocyte/lymphocyte ratio and cardiovascular disease mortality in peritoneal dialysis patients. Mediators Inflamm, 2020, 2020: 9852507.
2. Cai JJ, Wang K, Han T, et al. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Medicine, 2018, 97(46): 13-24.
3. Gijsberts CM, Ellenbroek G, Ten Berg MJ, et al. Effect of monocyte-to-lymphocyte ratio on heart failure characteristics and hospitalizations in a coronary angiography cohort. Am J Cardiol, 2017, 120(6): 911-916.
4. Xiang FF, Zhu JM, Cao XS, et al. Lymphocyte depletion and subset alteration correlate to renal function in chronic kidney disease patients. Renal Failure, 2016, 38(1): 7-14.
5. Liu HL, Zhan F, Wang YZ. Evaluation of monocyte-to-high-density lipoprotein cholesterol ratio and monocyte-to-lymphocyte ratio in ischemic stroke. J Int Med Res, 2020, 48(7): 300060520933806.
6. Cananzi F, Minerva EM, Samà L, et al. Preoperative monocyte-to-lymphocyte ratio predicts recurrence in gastrointestinal stromal tumors. J Surg Oncol, 2019, 119(1): 12-20.
7. Kimyon Cömert G, Türkmen O, Kar İ, et al. Independent predictors of survival in endometrium cancer: platelet-to-lymphocyte ratio and platelet/neutrophil/monocyte-to-lymphocyte ratio. J Turk Ger Gynecol Assoc, 2018, 19(2): 78-86.
8. Choi YH, Lee JW, Lee SH, et al. A high monocyte-to-lymphocyte ratio predicts poor prognosis in patients with advanced gallbladder cancer receiving chemotherapy. Cancer Epidemiol Biomarkers Prev, 2019, 28(6): 1045-1051.
9. Johnson AE, Pollard TJ, Shen L, et al. MIMIC-Ⅲ, a freely accessible critical care database. Sci Data, 2016, 3: 160035.
10. Chen QG, Zhang LS, Ge SH, et al. Prognosis predictive value of the Oxford Acute Severity of Illness Score for sepsis: a retrospective cohort study. PeerJ, 2019, 7: e7083.
11. Chen QC, Huang K, Li LL, et al. Serum uric acid on admission cannot predict long-term outcome of critically ill patients: a retrospective cohort study. Ther Clin Risk Manag, 2018, 14: 1347-1359.
12. Naess A, Nilssen SS, Mo R, et al. 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.
13. Wang JL, Lu XY, Xu XH, et al. Predictive role of monocyte-to-lymphocyte ratio in patients with Klebsiella pneumonia infection: a single-center experience. Medicine, 2019, 98(38): e17215.
14. Liu L, Wei Y, Wei X. The immune function of Ly6 Chi inflammatory monocytes during infection and inflammation. Curr Mol Med, 2017, 17(1): 4-12.
15. Bieber K, Autenrieth SE. Insights how monocytes and dendritic cells contribute and regulate immune defense against microbial pathogens. Immunobiology, 2015, 220(2): 215-226.
16. Tsuchimoto Y, Asai A, Tsuda Y, et al. M2b monocytes provoke bacterial pneumonia and gut bacteria-associated sepsis in alcoholics. J Immunol, 2015, 195(11): 5169-5177.
17. Liu YL, Zheng J, Zhang DS, et al. Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis. J Clin Lab Anal, 2019, 33(7): e22942.
18. Bosello O, Donataccio MP, Cuzzolaro M, et al. Obesity or obesities? Controversies on the association between body mass index and premature mortality. Eat Weight Disord, 2016, 21(2): 165-174.
19. Fleischmann E, Teal N, Dudley J, et al. Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int, 1999, 55(4): 1560-1567.
20. Kalantar-Zadeh K, Streja E, Kovesdy CP, et al. The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis. Mayo Clin Proc, 2010, 85(11): 991-1001.
21. Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes, 2009, 33(3): 289-295.
22. Kuk JL, Ardern CI, Church TS, et al. Edmonton Obesity Staging System: association with weight history and mortality risk. Appl Physiol Nutr Metab, 2011, 36(4): 570-576.
23. Chiappetta S, Sharma AM, Bottino V, et al. COVID-19 and the role of chronic inflammation in patients with obesity. Int J Obes, 2020, 44(8): 1790-1792.
24. Taşkın A, Can E, Hamilçıkan Ş, et al. Suspected or proven early-onset sepsis and NLR, PLR, and MPV parameters in neonates with born through MSAF[J/OL]. Am J Perinatol. (2020-10-08) https://dx.doi.org/10.1055/s-0040-1718369.
25. Chung H, Lee JH, Jo YH, et al. Circulating monocyte counts and its impact on outcomes in patients with severe sepsis including septic shock. Shock, 2019, 51(4): 423-429.

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