Association Between the Neutrophil:Lymphocyte Ratio After Hospitalization for Sepsis and Long-Term Outcomes: A Population-Based Cohort Study
Year: 2026
Type: article
Abstract: OBJECTIVES: Long-term outcomes after sepsis survival remain poor. No clinical laboratory tests are in use for stratifying long-term risk after sepsis, limiting the development of secondary prevention. The peripheral blood neutrophil:lymphocyte ratio (NLR) reflects innate and adaptive immune cell balance, and may reflect an immune milieu which is associated with long-term risk after sepsis. Accordingly, we evaluated the association between the NLR in the weeks after sepsis hospitalization discharge-a time when patients are routinely seen in post-ICU clinics-and long-term outcomes. DESIGN: Population-based cohort study. SETTING: Ontario, Canada, 2010-2020. PATIENTS: Adults discharged alive from a sepsis hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure was the first outpatient NLR-derived from the complete blood count-measured 15-90 days after sepsis discharge. Among 37,250 survivors with available NLR, the median (interquartile range [IQR]) time-to-measurement was 34 days (22-54 d), and the median NLR was 2.7 (1.8-4.2). Within 1 year, 17,732 patients (47.6%) were rehospitalized or died (median [IQR] time-to-event, 82 d [27-185 d]). The frequency of rehospitalization or death increased across increasing NLR quartiles: 34.2%, 41.5%, 50.3%, and 64.4% (ptrend < 0.001). Compared with the lowest quartile, adjusted hazard ratios (95% CI) were 1.24 (1.18-1.29), 1.54 (1.48-1.62), and 2.25 (2.15-2.35) across higher quartiles. For most patients, NLR after sepsis returned to its patient-specific presepsis ambient level, which was itself prognostic. CONCLUSIONS: Among sepsis survivors, outpatient NLR measured 15-90 days after discharge is strongly associated with 1-year risk of rehospitalization or death. As a simple, widely available biomarker, the NLR may support early postsepsis risk stratification and inform development of secondary prevention strategies.
Source: Critical Care Medicine
Authors: Patrick R. Lawler, Olivia Haldenby, Alice Chong, Manu Shankar-Hari, Peter C. Austin, Lucas L. Marinho, Leah Kosyakovsky, Federico Angriman, Alisa M. Higgins, Gabriele Lileikyte, Lucas C. Godoy, Guillaume Butler-Laporte, Damon C. Scales, Fernando G. Zampieri, Edy Y. Kim, Rebecca M. Baron, David E. Leaf, Cristina T. Pop, Michael C. Sklar, Jacob C. Jentzer, Michael E. Farkouh, Sylvain A. Lother, John C. Marshall, Ryan Zarychanski, James A. Russell, Derek C. Angus, Dennis T. Ko
Institutions: University of Toronto, McGill University Health Centre, King's College London, Beth Israel Deaconess Medical Center, Harvard University, Sunnybrook Hospital, Monash University, Lund University, Ottawa Heart Institute, University of Alberta, Brigham and Women's Hospital, St. Michael's Hospital, Mayo Clinic, Cedars-Sinai Smidt Heart Institute, University of Manitoba, University of British Columbia, University of Pittsburgh
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7225664584