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, 9 (1), 19756

Incorporation of Dynamic Segmented Neutrophil-To-Monocyte Ratio With Leukocyte Count for Sepsis Risk Stratification


Incorporation of Dynamic Segmented Neutrophil-To-Monocyte Ratio With Leukocyte Count for Sepsis Risk Stratification

Wen-Feng Fang et al. Sci Rep.


The association between sepsis and segmented neutrophil-to-monocyte (SeMo) ratio is unclear. We postulated that an increase in dynamic SeMo ratio measurement can be applied in risk stratification. This retrospective study included 727 consecutive sepsis patients in medical intensive care units (ICUs), including a subpopulation of 153 patients. According to the leukocyte (white blood cell, WBC) count on day 3 (normal range, between 4,000/µL and 12,000/µL) and delta SeMo (value of SeMo ratio on day 3 minus value of SeMo ratio on day 1; normal delta SeMo, <7), patients were grouped into 3 (delta SeMo & WBC tool). The survival lines separated significantly with hazard ratios of 1.854 (1.342-2.560) for the delta SeMo or WBC abnormal group and 2.860 (1.849-4.439) for the delta SeMo and WBC abnormal group compared to the delta SeMo and WBC normal group. Delta SeMo & WBC tool and delta sequential organ failure assessment (SOFA) tool performed better than the other tools (delta SeMo, delta WBC, day 3 WBC, and day 1 WBC). Severity in delta SeMo & WBC tool and delta SeMo tool reflected the immune dysfunction score, cytokine expression, and human leukocyte antigen D-related monocyte expression on day 1 and day 3. There was correspondence between delta SOFA and delta WBC and between delta SeMo and delta cytokine expression. Incorporation of dynamic SeMo ratio with WBC count provides risk stratification for sepsis patients admitted in the ICU.

Conflict of interest statement

The authors declare no competing interests.


Figure 1
Figure 1
Flowchart. Abbreviation: SeMo = segmented neutrophil-to-monocyte ratio.
Figure 2
Figure 2
(a) Mortality by the tools in all sepsis patients. Mortality outcomes are summarized in percentage for variables using Pearson chi-squared test. Statistical significances show a as P value < 0.05 and b as P value < 0.001. (b) Comparison of ROC curve among the eight tools. Pairwise comparison of receiver operating characteristic curves (the number represents the P value); *The italicized cells represent the P value in pairwise comparison for predicting the 14-day mortality; the normal cells represent the P value for predicting the 28-day mortality; ¥Statistically significant difference in predicting 14-day mortality; || Statistically significant difference in predicting 28-day mortality.
Figure 3
Figure 3
(a) Risk stratification by delta SeMo & WBC tool. (b) 28-day survival curve by the delta SeMo & WBC tool. Kaplan–Meier estimates of 28-day survival according to stratification by the SeMo & WBC tools in 727 sepsis patients.

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