Researchers have developed a novel nomogram prediction model based on the neutrophil to lymphocyte and platelet ratio (NLPR) to predict the risk of in-hospital mortality in children with sepsis. The study, published in the Journal of Inflammation Research, highlights the potential of NLPR as an independent predictor of mortality and provides a valuable tool for clinical decision-making.
Background and Significance
Sepsis remains a leading cause of mortality among children worldwide, with approximately 1.2 million new cases occurring annually. Early and accurate risk stratification is crucial for timely intervention and improved outcomes. Current prediction models often involve complex procedures and costly reagents, limiting their widespread implementation, particularly in resource-constrained settings. The NLPR, a readily available and cost-effective marker, has emerged as a promising prognostic indicator in various diseases.
Study Design and Methods
The retrospective cohort study included children diagnosed with sepsis and admitted to the Pediatric Intensive Care Unit (PICU) of Shenzhen Children’s Hospital between January 2019 and September 2021. The NLPR was calculated based on initial blood samples taken within 24 hours of PICU admission. The primary outcome was in-hospital mortality, and secondary outcomes included 30-day mortality, need for mechanical ventilation, and duration of PICU stay. A nomogram prediction model was developed incorporating NLPR, arterial blood lactate level, and the Pediatric Critical Illness Score (PCIS).
Key Findings
The study found that a high NLPR (greater than 2.34) was significantly associated with increased in-hospital mortality (40.7% vs 11.1%, P < 0.001) and 30-day mortality (37.2% vs 9.0%, P < 0.001). Multivariable logistic regression analysis identified NLPR as an independent risk factor for in-hospital mortality, along with arterial blood lactate and PCIS. The nomogram prediction model, integrating these three variables, demonstrated excellent accuracy, with an area under the curve (AUC) of 0.831 (95% CI 0.776–0.877).
Clinical Implications
The NLPR-based nomogram offers a simple and accessible tool for clinicians to assess the risk of mortality in pediatric sepsis patients. "This model not only enhances the accuracy of clinicians’ prognostic assessments for septic children but also facilitates prompt risk stratification upon PICU admission, guiding early and effective intervention strategies," the authors noted. The model's reliance on routinely tested indicators eliminates the need for additional blood sampling and incremental testing costs, making it particularly valuable in resource-limited settings.
Limitations and Future Directions
The study's limitations include its single-center, retrospective design, which may limit the generalizability of the findings. The authors acknowledge the need for external validation in independent cohorts and future prospective, multicenter studies to further enhance the robustness and applicability of the model.
Conclusion
The NLPR-based nomogram represents a promising tool for improving risk stratification and guiding clinical decision-making in pediatric sepsis. Its ease of use, cost-effectiveness, and high accuracy make it a valuable addition to the arsenal of tools available to clinicians caring for critically ill children.
