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

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: ,  ,  ,  ,   and    
Open Access
|Apr 2026
Figures & tables

Figures & Tables

Fig. 1.

Demographics of the main studied groups

Table 1.

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

ParameterSepsispa valueSeptic shockpa value
Day 1Day 5Day 1Day 5
SOFA, points9 (6.25)8 (9.25)0.031911 (6)8.5 (10.75)0.0314
APACHE II, points22 (12.5)20 (12.25)0.313727 (15)19.5 (23)0.9743
SAPS II, points60.5 (29)49 (30.5)0.087561 (39)44.5 (43)0.8909
NLMR18.04 (31.94)13.16 (29.55)0.814133.84 (47.25)14.01 (22.66)0.7990
PLR249.9 (269)204.2 (222.8)0.3027297.7 (309.1)224.1 (275.3)0.4319
Carboxyhemoglobin, %1.3 (0.95)0.9 (0.9)0.09441.1 (1.2)1 (1.1)0.4880
Ferritin, μg/L393 (481.8)386 (759)0.50441180 (1250)521 (859)0.3926

Legend:

a Wilcoxon test. Bold type indicates significance.

APACHE II – Acute Physiology And Chronic Health Evaluation II, NLMR – Neutrophil-to-Lymphocyte-to-Monocyte Ratio, PLR – Platelet-to-Lymphocyte Ratio, SAPS II – Simplified Acute Physiology Score II, SOFA – Sequential Organ Failure Assessment.

Table 2.

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

ParametersAPACHE II (points)SAPS II (points)
SOFA (points)SepsisDay 1r = 0.6879r = 0.6865
(95% CI: 0.529 to 0.8002)(95% CI: 0.5271 to 0.7992)
pb <0.0001pb <0.0001
Day 5r = 0.7559r = 0.7697
(95% CI: 0.5752 to 0.8663)(95% CI: 0.5968 to 0.8742)
pb <0.0001pb <0.0001
Septic shockDay 1r = 0.7966r = 0.6953
(95% CI: 0.6427 to 0.8888)(95% CI: 0.4866 to 0.829)
pb <0.0001pb <0.0001
Day 5r = 0.8393r = 0.8475
(95% CI: 0.6227 to 0.9364)(95% CI: 0.6398 to 0.9398)
pa <0.0001pa <0.0001
APACHE II (points)SepsisDay 1r = 0.8227
(95% CI: 0.7211 to 0.8896)
pb <0.0001
Day 5r = 0.8797
(95% CI: 0.7791 to 0.9361)
pb <0.0001
Septic shockDay 1r = 0.8836
(95% CI: 0.7877 to 0.9377)
pb <0.0001
Day 5r = 0.9575
(0.8937 to 0.9834)
pb <0.0001

Legend:

a Spearman test,

b Pearson test.

Bold type indicates significance. APACHE II – Acute Physiology And Chronic Health Evaluation II, SAPS II – Simplified Acute Physiology Score II, SOFA – Sequential Organ Failure Assessment, 95% CI – 95% confidence interval.

Fig. 2.

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

Table 3.

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

ParametersNLMRCOHb (%)Ferritin (μg/L)
PLRSepsisDay 1r = 0.3823r =−0.2078r =−0.2343
(95% CI: 0.1391 to 0.582)(95% CI:−0.4411 to 0.0517)(95% CI:−0.4632 to 0.024)
pa = 0.0022pa = 0.1051pa = 0.0669
Day 5r = 0.3949r =−0.1745r =−0.3216
(95% CI: 0.09414 to 0.6296)(95% CI:−0.472 to 0.1587)(95% CI:−0.5848 to 0.00291)
pa = 0.0097pa = 0.2881pa = 0.0459
Septic shockDay 1r = 0.4856r =−0.2406r = 0.0534
(95% CI: 0.1916 to 0.6997)(95% CI:−0.5169 to 0.08111)(95% CI:−0.2755 to 0.3712)
pa = 0.0017pb = 0.1402pa = 0.7466
Day 5r = 0.1558r =−0.1444r =−0.3063
(95% CI:−0.3082 to 0.5599)(95% CI:−0.5517 to 0.3184)(95% CI:−0.6594 to 0.1576)
pa = 0.4999pb = 0.5435pb = 0.189
NLMRSepsisDay 1r =−0.1283r = 0.2989
(95% CI:−0.3729 to 0.1329)(95% CI: 0.04561 to 0.5161)
pa = 0.3203pa = 0.0183
Day 5r =−0.0445r = 0.3542
(95% CI:−0.3635 to 0.2837)(95% CI: 0.03387 to 0.6085)
pa = 0.7877pa = 0.027
Septic shockDay 1r =−0.3976r = 0.1028
(95% CI:−0.6394 to −0.0842)(95% CI:−0.229 to 0.4132)
pa = 0.0122pa = 0.5333
Day 5r = 0.3455r = 0.05521
(95% CI:−0.1148 to 0.6836)(95% CI:−0.3972 to 0.4861)
pa = 0.125pa = 0.8121

Legend:

a Spearman test,

b Pearson test.

Bold type indicates significance. COHb – Carboxyhaemoglobin, NLMR – Neutrophil-to-Lymphocyte-to-Monocyte Ratio, PLR – Platelet-to-Lymphocyte Ratio, 95% CI – 95% confidence interval.

Fig. 4.

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

Table 4.

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

ParameterSurvivorspa valueNon-survivorspa value
Day 1Day 5Day 1Day 5
SOFA, points6 (6)2 (5.75)0.002811 (5)10 (8)0.0795
APACHE II, points14 (11.5)10.5 (10.75)0.094227 (12)22.5 (16)0.9814
SAPS II, points36 (28.5)28 (16)0.033565 (26)54 (29)0.6534
NLMR11.22 (23.54)9.722 (19.41)0.890623.74 (48.65)14.88 (28.28)0.5236
PLR257 (286.7)224.8 (308.5)0.8906283.2 (304.9)185.7 (207.7)0.1091
Carboxyhemoglobin, %1.35 (1.42)1 (0.95)0.11341.1 (1.1)0.9 (0.875)0.9928
Ferritin, μg/L393.5 (714.3)341.5 (548.7)0.5958666 (1296)458.5 (867)0.9113

Legend:

a Wilcoxon test.

Bold type indicates significance. APACHE II – Acute Physiology And Chronic Health Evaluation II, NLMR – Neutrophil-to-Lymphocyte-to-Monocyte Ratio, PLR – Platelet-to-Lymphocyte Ratio, SAPS II – Simplified Acute Physiology Score II, SOFA – Sequential Organ Failure Assessment.

Table 5.

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

ParametersAPACHE II (points)SAPS II (points)
SOFA (points)SurvivorsDay 1r = 0.6478r = 0.6398
(95% CI: 0.3371 to 0.8313)(95% CI: 0.3356 to 0.8231)
pa = 0.0003pb = 0.0004
Day 5r = 0.8628r = 0.7807
(95% CI: 0.6320 to 0.9530)(95% CI: 0.4523 to 0.9227)
pa <0.0001pa = 0.0005
Non-survivorsDay 1r = 0.6273r = 0.5823
(95% CI: 0.4655 to 0.7485)(95% CI: 0.4081 to 0.7156)
pb <0.0001pb <0.0001
Day 5r = 0.7256r = 0.6918
(95% CI: 0.5409 to 0.8435)(95% CI: 0.4911 to 0.8227)
pb <0.0001pb <0.0001
APACHE II (points)SurvivorsDay 1r = 0.7618
(95% CI: 0.5226 to 0.8899)
pa <0.0001
Day 5r = 0.6086
(95% CI: 0.1461 to 0.8528)
pa = 0.014
Non-survivorsDay 1r = 0.818
(95% CI: 0.7258 to 0.8814)
pb <0.0001
Day 5r = 0.9224
(95% CI: 0.8569 to 0.9586)
pa <0.0001

Legend:

a Spearman test,

b Pearson test.

Bold type indicates significance. APACHE II – Acute Physiology And Chronic Health Evaluation II, SAPS II – Simplified Acute Physiology Score II, SOFA – Sequential Organ Failure Assessment, 95% CI – 95% confidence interval.

Fig. 5.

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

Fig. 6.

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

Table 6.

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

ParametersNLMRCOHb (%)Ferritin (μg/L)
PLRSurvivorsDay 1r = 0.4099r = −0.2135r = −0.1768
(95% CI: 0.01474 to 0.6943)(95% CI: −0.5633 to 0.2011)(95% CI: −0.5366 to 0.2375)
pa = 0.0375pa = 0.2949pa = 0.3877
Day 5r = 0.6351r = −0.0295r = 0.1517
(95% CI: 0.2406 to 0.8495)(95% CI: −0.4897 to 0.4434)(95% CI: −0.3524 to 0.5875)
pa = 0.0035pb = 0.9072pa = 0.5479
Non-survivorsDay 1r = 0.4255r = −0.3133r = −0.07673
(95% CI: 0.2133 to 0.5994)(95% CI: −0.5095 to −0.08616)(95% CI: −0.3047 to 0.1596)
pa = 0.0001pa = 0.0062pa = 0.5129
Day 5r = 0.1619r = −0.1762r = −0.4354
(95% CI: −0.1507 to 0.445)(95% CI: −0.4664 to 0.1481)(95% CI: −0.6606 to −0.1383)
pa = 0.2938pa = 0.2704pa = 0.0044
NLMRSurvivorsDay 1r = −0.1283r = 0.1275
(95% CI: −0.3729 to 0.1329)(95% CI: −0.2845 to 0.4998)
pa = 0.3203pa = 0.5347
Day 5r = −0.0445r = 0.3168
(95% CI: −0.3635 to 0.2837)(95% CI: −0.1906 to 0.6906)
pa = 0.7877pa = 0.2002
Non-survivorsDay 1r = −0.1951r = 0.2358
(95% CI: −0.4099 to 0.04015)(95% CI: 0.002498 to 0.4447)
pa = 0.0935pa = 0.0417
Day 5r = 0.1046r = 0.1733
(95% CI: −0.2148 to 0.4037)(95% CI: −0.147 to 0.4607)
pa = 0.5099pa = 0.2723

Legend:

a Spearman test,

b Pearson test.

Bold type indicates significance. COHb – Carboxyhaemoglobin, NLMR – Neutrophil-to-Lymphocyte-to-Monocyte Ratio, PLR – Platelet-to-Lymphocyte Ratio, 95% CI – 95% confidence interval.

Fig. 7.

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

Table 7.

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 10–202 (9.53 μg/L)002 (9.53 μg/L)20–290 μg/L
21–10052 (54.9 μg/L)2 (44.3 μg/L)5
101–2006419
201–2906134
> 29145 (6220 μg/L)32 (7300 μg/L)20 (2700 μg/L)55 (7300 μg/L)
 
Day 50–201 (20.6 μg/L)001 (20.6 μg/L)
21–1003003
101–20055 (110 μg/L)5 (111 μg/L)5
201–2902011
> 29130 (4580 μg/L)16 (3050 μg/L)14 (2720 μg/L)32 (4580 μg/L)
Fig. 8.

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

Fig. 9.

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

Fig. 10.

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

Fig. 11.

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

DOI: https://doi.org/10.62838/jccm-2026-0009 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Journal RSS Feed
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,
severity scores
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
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)
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