Accuracy of neutrophil-lymphocyte and platelet-lymphocyte ratios as predictors of mortality in diabetic patients with necrotizing fasciitis
Keywords:
necrotizing fasciitis, mortality, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, diabetesAbstract
The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are widely recognized markers of systemic inflammation and immune responsiveness to infection. Elevated NLR and PLR levels are associated with poor prognoses in various conditions, including necrotizing fasciitis (NF). However, their accuracy in predicting mortality in diabetic patients with NF, who often exhibit immune dysfunction, remains unclear. This study aimed to evaluate the predictive accuracy of NLR and PLR for mortality in diabetic patients with NF. The retrospectively reviewed the medical records of type-2 diabetic patients with lower extremity NF treated at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, and Samut Prakan Hospital from January 2016 to December 2021. A total of 180 patients were included in the study, comprising 90 men and 90 women, with a mean age of 63.7 ± 12.1 years. Univariate analysis identified significant factors associated with mortality, including age ≥60 years (p=0.017), renal disease (p=0.007), NLR (p=0.006), platelet count <150 × 10^3/μL (p=0.007), blood glucose >200 mg/dL (p=0.033), and creatinine >2 mg/dL (p<0.001). Receiver operating characteristic (ROC) curve analysis revealed that the optimal cut-off point for NLR was 14.3 (AUC 0.632; 95% CI 0.541–0.723, p=0.007), with a sensitivity of 60.6% and specificity of 66.7%. In contrast, PLR did not demonstrate predictive value for mortality (AUC 0.447; 95% CI 0.349–0.545, p=0.278). Multivariate analysis indicated that a platelet count <150 × 10^3/μL, NLR ≥14.3, and creatinine >2 mg/dL were significant risk factors for mortality. In conclusion, NLR ≥14.3 was independently associated with an increased risk of mortality in diabetic patients with NF; however, its low accuracy limits its usefulness as a reliable prognostic test. Conversely, PLR was not found to be a predictor of mortality.
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