PLATELET-LYMPHOCYTE RATIO AFTER GRANULOCYTE COLONY STIMULATING FACTOR ADMINISTRATION: AN EARLY PROGNOSTIC MARKER IN SEPTIC SHOCK PATIENTS WITH CHEMOTHERAPY-INDUCED FEBRILE NEUTROPENIA

Abstract

Introduction: Chemotherapy-induced febrile neutropenia (FN) causes life-threatening complications, but little is known in septic shock patients with FN. The aim of this study was to investigate the prognostic value of inflammatory markers, including C-reactive protein level, immature granulocyte count, white blood cell (WBC) count, absolute neutrophil count (ANC), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), in septic shock patients with FN at admission and after granulocyte colony-stimulating factor (G-CSF) administration. Methods: Data on consecutive adult septic shock patients with FN treated with G-CSF between June 2012 and June 2017 were extracted from a prospectively compiled septic shock registry. Clinical and serial laboratory data at admission and < 24 h after G-CSF administration were compared between nonsurvivor and 1-month survivor groups. Results: Of 1,671 septic shock patients, 158 FN patients were treated with G-CSF and 114 (72.2%) survived for 1 month. At admission, no clinical and serial laboratory data were significant to predict survival. After G-CSF administration, PLR and APACHE II were independent predictors for 1-month survival. PLR after administration of G-CSF > 100 (adjusted odds ratio [aOR], 9.394; 95% CI, 2.821-31.285, P < 0.001) showed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 89.4%, 46.2%, 82.9%, and 60.0%, respectively, and APACHE II < 28 (aOR, 6.944; 95% CI, 2.351-20.511, P< 0.001) showed sensitivity, specificity, PPV, and NPVof 86.8%, 63.6%, 86.1%, and 65.1%, respectively. Conclusions: After G-CSF administration in septic shock patients with chemotherapy-induced FN, PLR may be used as an early prognostic marker for mortality.