Predictive value of NLMR, PLR, and ferritin in relation to SOFA, APACHE II, and SAPS II in sepsis patients

Oana Coman; Bianca-Liana Grigorescu; Adina Hutanu; Stefania Raluca Fodor; Marius Petrisor; Leonard Azamfirei

doi:10.62838/jccm-2026-0009

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Predictive value of NLMR, PLR, and ferritin in relation to SOFA, APACHE II, and SAPS II in sepsis patients

The Journal of Critical Care Medicine

Volume 12 (2026): Issue 2 (April 2026)

By: Oana Coman, Bianca-Liana Grigorescu, Adina Hutanu, Stefania Raluca Fodor, Marius Petrisor and Leonard Azamfirei

Open Access

|Apr 2026

Figures & Tables

Correlations between APACHE II score and SAPS II score with Ferritin on day 5 for sepsis and septic shock groups.

Correlations between cellular ratios and severity scores on day 1 and 5 in the septic shock group.

Correlations between severity scores and COHb on day 1 and day 5 in the survivor and non-survivor groups.

Correlations between severity scores and ferritin on day 5 in the non-survivor group.

Correlations between PLR and severity scores on day 5 in the non-survivor group.

ROC curve for NLMR on day 1 and day 5. Legend: AUC – Area under curve, 95% CI – 95% confidence interval.

ROC curve for SOFA score on day 1 and day 5. Legend: AUC – Area under curve, 95% CI – 95% confidence interval.

ROC curve for APACHE II score on day 1 and day 5. Legend: AUC – Area under curve, 95% CI – 95% confidence interval.

ROC curve for SAPS II score on day 1 and day 5. AUC – Area under curve, 95% CI – 95% confidence interval.

Correlations of cellular ratios for survivor and non-survivor patients on day 1 and day 5

Parameters			NLMR	COHb (%)	Ferritin (μg/L)
PLR	Survivors	Day 1	r = 0.4099	r = −0.2135	r = −0.1768
			(95% CI: 0.01474 to 0.6943)	(95% CI: −0.5633 to 0.2011)	(95% CI: −0.5366 to 0.2375)
			p^a = 0.0375	p^a = 0.2949	p^a = 0.3877

		Day 5	r = 0.6351	r = −0.0295	r = 0.1517
			(95% CI: 0.2406 to 0.8495)	(95% CI: −0.4897 to 0.4434)	(95% CI: −0.3524 to 0.5875)
			p^a = 0.0035	p^b = 0.9072	p^a = 0.5479

	Non-survivors	Day 1	r = 0.4255	r = −0.3133	r = −0.07673
			(95% CI: 0.2133 to 0.5994)	(95% CI: −0.5095 to −0.08616)	(95% CI: −0.3047 to 0.1596)
			p^a = 0.0001	p^a = 0.0062	p^a = 0.5129

		Day 5	r = 0.1619	r = −0.1762	r = −0.4354
			(95% CI: −0.1507 to 0.445)	(95% CI: −0.4664 to 0.1481)	(95% CI: −0.6606 to −0.1383)
			p^a = 0.2938	p^a = 0.2704	p^a = 0.0044

NLMR	Survivors	Day 1		r = −0.1283	r = 0.1275
				(95% CI: −0.3729 to 0.1329)	(95% CI: −0.2845 to 0.4998)
				p^a = 0.3203	p^a = 0.5347

		Day 5		r = −0.0445	r = 0.3168
				(95% CI: −0.3635 to 0.2837)	(95% CI: −0.1906 to 0.6906)
				p^a = 0.7877	p^a = 0.2002

	Non-survivors	Day 1		r = −0.1951	r = 0.2358
				(95% CI: −0.4099 to 0.04015)	(95% CI: 0.002498 to 0.4447)
				p^a = 0.0935	p^a = 0.0417

		Day 5		r = 0.1046	r = 0.1733
				(95% CI: −0.2148 to 0.4037)	(95% CI: −0.147 to 0.4607)
				p^a = 0.5099	p^a = 0.2723

Comparison of the studied parameters between survivors and non-survivor patients on day 1 and day 5 (median value and interquartile range (IQR))_

Parameter	Survivors		p^a value	Non-survivors		p^a value

	Day 1	Day 5		Day 1	Day 5
SOFA, points	6 (6)	2 (5.75)	0.0028	11 (5)	10 (8)	0.0795
APACHE II, points	14 (11.5)	10.5 (10.75)	0.0942	27 (12)	22.5 (16)	0.9814
SAPS II, points	36 (28.5)	28 (16)	0.0335	65 (26)	54 (29)	0.6534
NLMR	11.22 (23.54)	9.722 (19.41)	0.8906	23.74 (48.65)	14.88 (28.28)	0.5236
PLR	257 (286.7)	224.8 (308.5)	0.8906	283.2 (304.9)	185.7 (207.7)	0.1091
Carboxyhemoglobin, %	1.35 (1.42)	1 (0.95)	0.1134	1.1 (1.1)	0.9 (0.875)	0.9928
Ferritin, μg/L	393.5 (714.3)	341.5 (548.7)	0.5958	666 (1296)	458.5 (867)	0.9113

Patient classification according to ferritin value, with lowest and highest value for each subgroup

	Intervals (μg/L)	Sepsis (N = 62; 41)	Septic shock (N = 39; 21)	Survivors (N = 26; 20)	Non-survivors (N = 75; 42)	Reference interval
Day 1	0–20	2 (9.53 μg/L)	0	0	2 (9.53 μg/L)	20–290 μg/L
	21–100	5	2 (54.9 μg/L)	2 (44.3 μg/L)	5
	101–200	6	4	1	9
	201–290	6	1	3	4
	> 291	45 (6220 μg/L)	32 (7300 μg/L)	20 (2700 μg/L)	55 (7300 μg/L)

Day 5	0–20	1 (20.6 μg/L)	0	0	1 (20.6 μg/L)
	21–100	3	0	0	3
	101–200	5	5 (110 μg/L)	5 (111 μg/L)	5
	201–290	2	0	1	1
	> 291	30 (4580 μg/L)	16 (3050 μg/L)	14 (2720 μg/L)	32 (4580 μg/L)

Comparison of the studied parameters between sepsis and septic shock patients on day 1 and day 5 (median value and interquartile range (IQR))_

Parameter	Sepsis		p^a value	Septic shock		p^a value

	Day 1	Day 5		Day 1	Day 5
SOFA, points	9 (6.25)	8 (9.25)	0.0319	11 (6)	8.5 (10.75)	0.0314
APACHE II, points	22 (12.5)	20 (12.25)	0.3137	27 (15)	19.5 (23)	0.9743
SAPS II, points	60.5 (29)	49 (30.5)	0.0875	61 (39)	44.5 (43)	0.8909
NLMR	18.04 (31.94)	13.16 (29.55)	0.8141	33.84 (47.25)	14.01 (22.66)	0.7990
PLR	249.9 (269)	204.2 (222.8)	0.3027	297.7 (309.1)	224.1 (275.3)	0.4319
Carboxyhemoglobin, %	1.3 (0.95)	0.9 (0.9)	0.0944	1.1 (1.2)	1 (1.1)	0.4880
Ferritin, μg/L	393 (481.8)	386 (759)	0.5044	1180 (1250)	521 (859)	0.3926

Correlations of cellular ratios for sepsis and septic shock patients on day 1 and day 5

Parameters			NLMR	COHb (%)	Ferritin (μg/L)
PLR	Sepsis	Day 1	r = 0.3823	r =−0.2078	r =−0.2343
			(95% CI: 0.1391 to 0.582)	(95% CI:−0.4411 to 0.0517)	(95% CI:−0.4632 to 0.024)
			p^a = 0.0022	p^a = 0.1051	p^a = 0.0669

		Day 5	r = 0.3949	r =−0.1745	r =−0.3216
			(95% CI: 0.09414 to 0.6296)	(95% CI:−0.472 to 0.1587)	(95% CI:−0.5848 to 0.00291)
			p^a = 0.0097	p^a = 0.2881	p^a = 0.0459

	Septic shock	Day 1	r = 0.4856	r =−0.2406	r = 0.0534
			(95% CI: 0.1916 to 0.6997)	(95% CI:−0.5169 to 0.08111)	(95% CI:−0.2755 to 0.3712)
			p^a = 0.0017	p^b = 0.1402	p^a = 0.7466

		Day 5	r = 0.1558	r =−0.1444	r =−0.3063
			(95% CI:−0.3082 to 0.5599)	(95% CI:−0.5517 to 0.3184)	(95% CI:−0.6594 to 0.1576)
			p^a = 0.4999	p^b = 0.5435	p^b = 0.189

NLMR	Sepsis	Day 1		r =−0.1283	r = 0.2989
				(95% CI:−0.3729 to 0.1329)	(95% CI: 0.04561 to 0.5161)
				p^a = 0.3203	p^a = 0.0183

		Day 5		r =−0.0445	r = 0.3542
				(95% CI:−0.3635 to 0.2837)	(95% CI: 0.03387 to 0.6085)
				p^a = 0.7877	p^a = 0.027

	Septic shock	Day 1		r =−0.3976	r = 0.1028
				(95% CI:−0.6394 to −0.0842)	(95% CI:−0.229 to 0.4132)
				p^a = 0.0122	p^a = 0.5333

		Day 5		r = 0.3455	r = 0.05521
				(95% CI:−0.1148 to 0.6836)	(95% CI:−0.3972 to 0.4861)
				p^a = 0.125	p^a = 0.8121

Correlations of severity scores for sepsis and septic shock groups on day 1 and day 5

Parameters			APACHE II (points)	SAPS II (points)
SOFA (points)	Sepsis	Day 1	r = 0.6879	r = 0.6865
			(95% CI: 0.529 to 0.8002)	(95% CI: 0.5271 to 0.7992)
			p^b <0.0001	p^b <0.0001

		Day 5	r = 0.7559	r = 0.7697
			(95% CI: 0.5752 to 0.8663)	(95% CI: 0.5968 to 0.8742)
			p^b <0.0001	p^b <0.0001

	Septic shock	Day 1	r = 0.7966	r = 0.6953
			(95% CI: 0.6427 to 0.8888)	(95% CI: 0.4866 to 0.829)
			p^b <0.0001	p^b <0.0001

		Day 5	r = 0.8393	r = 0.8475
			(95% CI: 0.6227 to 0.9364)	(95% CI: 0.6398 to 0.9398)
			p^a <0.0001	p^a <0.0001

APACHE II (points)	Sepsis	Day 1		r = 0.8227
				(95% CI: 0.7211 to 0.8896)
				p^b <0.0001

		Day 5		r = 0.8797
				(95% CI: 0.7791 to 0.9361)
				p^b <0.0001

	Septic shock	Day 1		r = 0.8836
				(95% CI: 0.7877 to 0.9377)
				p^b <0.0001

		Day 5		r = 0.9575
				(0.8937 to 0.9834)
				p^b <0.0001

Correlations of severity scores for survivors and non-survivors on day 1 and day 5

Parameters			APACHE II (points)	SAPS II (points)
SOFA (points)	Survivors	Day 1	r = 0.6478	r = 0.6398
			(95% CI: 0.3371 to 0.8313)	(95% CI: 0.3356 to 0.8231)
			p^a = 0.0003	p^b = 0.0004

		Day 5	r = 0.8628	r = 0.7807
			(95% CI: 0.6320 to 0.9530)	(95% CI: 0.4523 to 0.9227)
			p^a <0.0001	p^a = 0.0005

	Non-survivors	Day 1	r = 0.6273	r = 0.5823
			(95% CI: 0.4655 to 0.7485)	(95% CI: 0.4081 to 0.7156)
			p^b <0.0001	p^b <0.0001

		Day 5	r = 0.7256	r = 0.6918
			(95% CI: 0.5409 to 0.8435)	(95% CI: 0.4911 to 0.8227)
			p^b <0.0001	p^b <0.0001

APACHE II (points)	Survivors	Day 1		r = 0.7618
				(95% CI: 0.5226 to 0.8899)
				p^a <0.0001

		Day 5		r = 0.6086
				(95% CI: 0.1461 to 0.8528)
				p^a = 0.014

	Non-survivors	Day 1		r = 0.818
				(95% CI: 0.7258 to 0.8814)
				p^b <0.0001

		Day 5		r = 0.9224
				(95% CI: 0.8569 to 0.9586)
				p^a <0.0001

References

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Articles in this issue

DOI: https://doi.org/10.62838/jccm-2026-0009 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 215 - 231

Submitted on: Jan 18, 2026

Accepted on: Feb 9, 2026

Published on: Apr 30, 2026

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

sepsis,

septic shock,

NLMR,

PLR,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2026 Oana Coman, Bianca-Liana Grigorescu, Adina Hutanu, Stefania Raluca Fodor, Marius Petrisor, Leonard Azamfirei, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 12 (2026): Issue 2 (April 2026)

Predictive value of NLMR, PLR, and ferritin in relation to SOFA, APACHE II, and SAPS II in sepsis patients

Figures & Tables

Fig. 1.

Fig. 2.

Fig. 4.

Fig. 5.

Fig. 6.

Fig. 7.

Fig. 8.

Fig. 9.

Fig. 10.

Fig. 11.

Correlations of cellular ratios for survivor and non-survivor patients on day 1 and day 5

Comparison of the studied parameters between survivors and non-survivor patients on day 1 and day 5 (median value and interquartile range (IQR))_

Patient classification according to ferritin value, with lowest and highest value for each subgroup

Comparison of the studied parameters between sepsis and septic shock patients on day 1 and day 5 (median value and interquartile range (IQR))_

Correlations of cellular ratios for sepsis and septic shock patients on day 1 and day 5

Correlations of severity scores for sepsis and septic shock groups on day 1 and day 5

Correlations of severity scores for survivors and non-survivors on day 1 and day 5

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