NEUTROPHIL TO LYMPHOCYTE RATIO AND PLATELET TO LYMPHOCYTE RATIO AS A PROGNOSTIC INDICATOR FOR POST-OPERATIVE LAPAROTOMY PATIENTS IN INTENSIVE CARE UNIT- A PROSPECTIVE OBSERVATIONAL STUDY alysmanwar@yahoo.co.in

 

NEUTROPHIL TO LYMPHOCYTE RATIO AND PLATELET TO LYMPHOCYTE RATIO AS A PROGNOSTIC INDICATOR FOR POST-OPERATIVE LAPAROTOMY PATIENTS IN INTENSIVE CARE UNIT- A PROSPECTIVE OBSERVATIONAL STUDY

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India

Oral or Poster

Postoperative outcomes in patients undergoing laparotomy are significantly influenced by the body’s inflammatory response. Traditional prognostic tools such as APACHE and SOFA have limitations. Hematological markers, such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have emerged as potential early prognostic indicators for critically ill surgical patients.

This prospective observational study was conducted in the Department of General Surgery, AIIMS Bhubaneswar. Patients undergoing laparotomy who required ICU admission for 24 hours were included. Baseline, daily NLR and PLR were calculated from routine complete blood counts. Serial measurements of C-reactive protein, serum lactate, and procalcitonin were also recorded. The primary outcome was survival; secondary outcomes included ICU length of stay and correlation of hematological ratios with recovery milestones. Multivariate and ROC analyses were calculated.

150 patients were included (74.3% male, age 51.2±17.2 years; 113 emergency). ICU mortality was 17.3%. NLR at baseline (>6.0) and Day 4 (>8.0) strongly predicted prolonged ICU stay (>4 days) and mortality (OR 2.47 and 3.85, respectively, p<0.05). Non-survivors had higher serial NLR (Day 8: 12.05 vs 7.86 in survivors, p<0.001). PLR correlated weakly. NLR was significantly associated with delayed weaning from ventilator and catheter removal. ROC analysis: NLR outperformed PLR, CRP, and lactate, and rivaled procalcitonin in prognostic accuracy.

Serial NLR measurement provides a simple, reliable, and affordable prognostic tool for early identification of high-risk post-laparotomy ICU patients and matching markers like procalcitonin. Widespread adoption could enhance early intervention and resource allocation in critical care.