Platelet-Lymphocyte Ratio After Granulocyte Colony Stimulating Factor Administration: An Early Prognostic Marker in Septic Shock Patients with Chemotherapy-Induced Febrile Neutropenia


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Abstract

Introduction:Chemotherapy-induced febrile neutropenia (FN) causes life-threatening complications, but little is known in septic shock patients with FN. The aim of this study was to investigate the prognostic value of inflammatory markers, including C-reactive protein level, immature granulocyte count, white blood cell (WBC) count, absolute neutrophil count (ANC), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), in septic shock patients with FN at admission and after granulocyte colony-stimulating factor (G-CSF) administration.Methods:Data on consecutive adult septic shock patients with FN treated with G-CSF between June 2012 and June 2017 were extracted from a prospectively compiled septic shock registry. Clinical and serial laboratory data at admission and <24 h after G-CSF administration were compared between non-survivor and one-month survivor groups.Results:Of 1671 septic shock patients, 158 FN patients were treated with G-CSF and 114 (72.2%) survived for one month. At admission, no clinical and serial laboratory data were significant to predict survival. After G-CSF administration, PLR and APACHE II were independent predictors for one-month survival. PLR after administration of G-CSF >100 (adjusted odds ratio [AOR], 9.394; 95% CI, 2.821–31.285, P < 0.001) showed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 89.4%, 46.2%, 82.9%, and 60.0%, respectively and APACHE II < 28 (AOR, 6.944; 95% CI, 2.351–20.511, P < 0.001) showed sensitivity, specificity, PPV, and NPV of 86.8%, 63.6%, 86.1%, and 65.1%, respectively.Conclusions:After G-CSF administration in septic shock patients with chemotherapy-induced FN, PLR may be used as an early prognostic marker for mortality.

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