Abstract

Background: This study aimed to evaluate the association between the Neutrophil to-Lymphocyte Ratio (NLR) and outcome of septic patients with atrial fibrillation.

Methods: Patients with sepsis and AF from the Medical Information Mart For Intensive Care-IV (MIMIC-IV) database had their baseline data and in-hospital prognosis retrieved. Multivariable logistics regression analyses were applied to calculate adjusted Odds Ratios (OR) with 95% Confidence Intervals (CI). Survival curves were plotted, and subgroup analyses were stratified by relevant covariates. To address the linearity relationship, curve fitting were performed. 

Results: Of the 7,241 patients, 5,864 patients with sepsis and AF were included. The overall in-hospital mortality rate was 21.1% (1,235/4,629). Adjusted for confounding factors in the multivariable logistics regression analysis models, when NLR was used as a categorical variable, patients in the highest NLR tertile had increased in-hospital mortality compared to patients in the lowest NLR tertile (HR=1.31, 95% CI: 1.09–1.58). A linear relationship between NLR and in-hospital mortality was found in patients with sepsis and AF. K-M curves showed the in-hospital mortality rate was highest in group 3 (NLR 8.4) than in the other two groups. Stratified analyses indicated that the correlation between the NLR and in-hospital mortality was stable. 

Conclusion: There is a linear relationship between NLR and in-hospital mortality in intensive care of septic patients with atrial fibrillation. A higher NLR in ICU patients is associated with in-hospital mortality in the United States. However, further research is needed to confirm the findings.

Keywords: Intensive care unit; Infection; Platelet-lymphocyte ratio; Red cell distribution width; Massachusetts institute of technology