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

Lin X, Zhang L, Wang Y, Huang T, Lin X, Hong X, et al. Application of neutrophil-to-lymphocyte-to-monocyte ratio in predicting mortality risk in adult patients with septic shock: a retrospective cohort study conducted at a single center. Heliyon. 2024;10(7):e28809. doi:10.1016/j.heliyon.2024.e28809.
Open DOI Search in Google Scholar Back to article
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–810. doi:10.1001/jama.2016.0287.
Open DOI Search in Google Scholar Back to article
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017. Lancet. 2020;395(10219):200–211. doi:10.1016/S0140-6736(19)32989-7.
Open DOI Search in Google Scholar Back to article
World Health Organization. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions. Geneva: World Health Organization; 2020.
Search in Google Scholar Back to article
van den Berg M, van Beuningen FE, Ter Maaten JC, Bouma HR. Hospital-related costs of sepsis around the world: a systematic review exploring the economic burden of sepsis. J Crit Care. 2022;71:154096. doi:10.1016/j.jcrc.2022.154096.
Open DOI Search in Google Scholar Back to article
de Nooijer AH, Pickkers P, Netea MG, Kox M. Inflammatory biomarkers to predict the prognosis of acute bacterial and viral infections. J Crit Care. 2023;78:154360. doi:10.1016/j.jcrc.2023.154360.
Open DOI Search in Google Scholar Back to article
Stanski NL, Wong HR. Prognostic and predictive enrichment in sepsis. Nat Rev Nephrol. 2020;16(1):20–31. doi:10.1038/s41581-019-0199-3.
Open DOI Search in Google Scholar Back to article
Coman O, Grigorescu BL, Huțanu A, Bacârea A, Văsieșiu AM, Fodor RȘ, et al. The role of programmed cell death 1/programmed death ligand 1 (PD-1/PD-L1) axis in sepsis-induced apoptosis. Medicina (Kaunas). 2024;60(7):1174. doi:10.3390/medicina60071174.
Open DOI Search in Google Scholar Back to article
Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474–488. doi:10.4149/BLL_2021_078.
Open DOI Search in Google Scholar Back to article
Wu H, Cao T, Ji T, Luo Y, Huang J, Ma K. Predictive value of the neutrophil-to-lymphocyte ratio in the prognosis and risk of death for adult sepsis patients: a meta-analysis. Front Immunol. 2024;15:1336456. doi:10.3389/fimmu.2024.1336456.
Open DOI Search in Google Scholar Back to article
Wang G, Mivefroshan A, Yaghoobpoor S, Khanzadeh S, Siri G, Rahmani F, et al. Prognostic value of platelet to lymphocyte ratio in sepsis: a systematic review and meta-analysis. Biomed Res Int. 2022;2022:9056363. doi:10.1155/2022/9056363.
Open DOI Search in Google Scholar Back to article
Espinoza VE, Emmady PD. Histology, monocytes. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
Search in Google Scholar Back to article
Kriplani A, Pandit S, Chawla A, de la Rosette JJMCH, Laguna P, Jayadeva Reddy S, et al. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and lymphocyte-monocyte ratio in predicting systemic inflammatory response syndrome and sepsis after percutaneous nephrolithotomy. Urolithiasis. 2022;50(3):341–348. doi:10.1007/s00240-022-01319-0.
Open DOI Search in Google Scholar Back to article
Lelubre C, Vincent JL. Mechanisms and treatment of organ failure in sepsis. Nat Rev Nephrol. 2018;14(7):417–427. doi:10.1038/s41581-018-0005-7.
Open DOI Search in Google Scholar Back to article
McArdle AJ, Webbe J, Sim K, Parrish G, Hoggart C, Wang Y, et al. Determinants of carboxyhemoglobin levels and relationship with sepsis in preterm neonates. PLoS One. 2016;11(8):e0161784. doi:10.1371/journal.pone.0161784.
Open DOI Search in Google Scholar Back to article
Schuster FS, Nyvlt P, Heeren P, Spies C, Adam MF, Schenk T, et al. Differential diagnosis of hyperferritinemia in critically ill patients. J Clin Med. 2022;12(1):192. doi:10.3390/jcm12010192.
Open DOI Search in Google Scholar Back to article
Moreira AC, Mesquita G, Gomes MS. Ferritin: an inflammatory player keeping iron at the core of pathogen-host interactions. Microorganisms. 2020;8(4):589. doi:10.3390/microorganisms8040589.
Open DOI Search in Google Scholar Back to article
Ueda N, Takasawa K. Impact of inflammation on ferritin, hepcidin and the management of iron deficiency anemia in chronic kidney disease. Nutrients. 2018;10(9):1173. doi:10.3390/nu10091173.
Open DOI Search in Google Scholar Back to article
Cheng L, Li H, Li L, Liu C, Yan S, Chen H, et al. Ferritin in coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. J Clin Lab Anal. 2020;34(10):e23618. doi:10.1002/jcla.23618.
Open DOI Search in Google Scholar Back to article
Francois B, Jeannet R, Daix T, Walton AH, Shotwell MS, Unsinger J, et al. Interleukin-7 restores lymphocytes in septic shock: the IRIS-7 randomized clinical trial. JCI Insight. 2018;3(5):e98960. doi:10.1172/jci.insight.98960.
Open DOI Search in Google Scholar Back to article
Baker RE, Mahmud AS, Miller IF, Rajeev M, Rasambainarivo F, Rice BL, et al. Infectious disease in an era of global change. Nat Rev Microbiol. 2022;20(4):193–205. doi:10.1038/s41579-021-00639-z.
Open DOI Search in Google Scholar Back to article
Arefian H, Heublein S, Scherag A, Brunkhorst FM, Younis MZ, Moerer O, et al. Hospital-related cost of sepsis: a systematic review. J Infect. 2017;74(2):107–117. doi:10.1016/j.jinf.2016.11.006.
Open DOI Search in Google Scholar Back to article
Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019. Crit Care. 2020;24(1):239. doi:10.1186/s13054-020-02950-2.
Open DOI Search in Google Scholar Back to article
Fleischmann-Struzek C, Mellhammar L, Rose N, Cassini A, Rudd KE, Schlattmann P, et al. Incidence and mortality of hospital- and ICU-treated sepsis. Intensive Care Med. 2020;46(8):1552–1562. doi:10.1007/s00134-020-06151-x.
Open DOI Search in Google Scholar Back to article
Liu D, Huang SY, Sun JH, Zhang HC, Cai QL, Gao C, et al. Sepsis-induced immunosuppression: mechanisms, diagnosis and current treatment options. Mil Med Res. 2022;9(1):56. doi:10.1186/s40779-022-00422-y.
Open DOI Search in Google Scholar Back to article
van der Poll T, Shankar-Hari M, Wiersinga WJ. The immunology of sepsis. Immunity. 2021;54(11):2450–2464. doi:10.1016/j.immuni.2021.10.012.
Open DOI Search in Google Scholar Back to article
Pei F, Yao RQ, Ren C, Bahrami S, Billiar TR, Chaudry IH, et al. Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression. Mil Med Res. 2022;9(1):74. doi:10.1186/s40779-022-00430-y.
Open DOI Search in Google Scholar Back to article
van Vught LA, Klein Klouwenberg PMC, Spitoni C, Scicluna BP, Wiewel MA, Horn J, et al. Incidence, risk factors, and attributable mortality of secondary infections after sepsis. JAMA. 2016;315(14):1469–1479. doi:10.1001/jama.2016.2691.
Open DOI Search in Google Scholar Back to article
Georgescu AM, Szederjesi J, Dobreanu M, Copotoiu SM, Voidăzan S, Huțanu A, et al. Soluble urokinase-type plasminogen activator receptor (suPAR) – a possible biomarker for bacteremia in sepsis. Rom Rev Lab Med. 2015;23(1):59–73.
Search in Google Scholar Back to article
Hai PD, Viet Hoa LT. Prognostic accuracy evaluation of mNUTRIC, APACHE II, SOFA and SAPS 2 scores for mortality prediction in patients with sepsis. Crit Care Res Pract. 2022;2022:4666594. doi:10.1155/2022/4666594.
Open DOI Search in Google Scholar Back to article
Liengswangwong W, Siriwannabhorn R, Leela-Amornsin S, Yuksen C, Sanguanwit P, Duangsri C, et al. Comparison of MEWS, SAPS II, SOFA and APACHE II for early prediction of septic shock. BMC Emerg Med. 2024;24(1):161. doi:10.1186/s12873-024-01078-8.
Open DOI Search in Google Scholar Back to article
Fuchs PA, Czech IJ, Krzych ŁJ. The pros and cons of mortality prediction in the ICU. Int J Environ Res Public Health. 2019;16(18):3394. doi:10.3390/ijerph16183394.
Open DOI Search in Google Scholar Back to article
Luka S, Golea A, Vesa ȘC, Leahu CE, Zăgănescu R, Ionescu D. Can we improve mortality prediction in patients with sepsis in the emergency department? Medicina (Kaunas). 2024;60(8):1333. doi:10.3390/medicina60081333.
Open DOI Search in Google Scholar Back to article
Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol. 2017;29(9):401–409. doi:10.1093/intimm/dxx031.
Open DOI Search in Google Scholar Back to article
Sang L, Teng W, Zhao M, Ding P, Xu X, Wang Y, et al. Association between serum ferritin and outcomes in critically ill patients. Chin Med J. 2022;135(21):2634–2636. doi:10.1097/CM9.0000000000002019.
Open DOI Search in Google Scholar Back to article
Cao M, Wang G, Xie J. Immune dysregulation in sepsis: experiences, lessons and perspectives. Cell Death Discov. 2023;9(1):465. doi:10.1038/s41420-023-01766-7.
Open DOI Search in Google Scholar Back to article
Văsiesiu AM, Coman O, Fodor RS, Bacârea A, Grigorescu BL. Insights into sepsis-induced apoptosis: interplay between programmed cell death and interleukin-7. J Crit Care Med. 2025;11(2):132–139. doi:10.2478/jccm-2025-0003.
Open DOI Search in Google Scholar Back to article
Kovacs J, Gurzu S, Jung J, Szederjesi J, Copotoiu SM, Copotoiu R, et al. Clinico-pathological particularities of shock-related pancreatitis. Pathol Oncol Res. 2012;18(4):977–981. doi:10.1007/s12253-012-9528-6.
Open DOI Search in Google Scholar Back to article
Coman O, Grigorescu BL, Huțanu A, Bacârea A, Văsieșiu AM, Fodor RȘ, et al. The role of PD-1/PD-L1 and IL-7 in lymphocyte dynamics and sepsis progression. Int J Mol Sci. 2024;25(23):12612. doi:10.3390/ijms252312612.
Open DOI Search in Google Scholar Back to article
Chen Y, Feng F, Li M, Yuan JJ, Chang XN, Wei BH, et al. Relationship between platelet/lymphocyte ratio and prognosis of patients with septic acute kidney injury. J Chin Med Assoc. 2020;83(11):1004–1007. doi:10.1097/JCMA.0000000000000404.
Open DOI Search in Google Scholar Back to article
Jiang J, Du H, Su Y, Li X, Zhang J, Chen M, et al. Nonviral infection-related lymphocytopenia for the prediction of adult sepsis. Medicine (Baltimore). 2019;98(29):e16535. doi:10.1097/MD.0000000000016535.
Open DOI Search in Google Scholar Back to article
Grigorescu BL, Coman O, Văsieșiu AM, Bacârea A, Petrișor M, Săplăcan I, et al. Is carboxyhaemoglobin an effective bedside prognostic tool for sepsis and septic shock patients? J Crit Care Med. 2023;9(4):239–251. doi:10.2478/jccm-2023-0031.
Open DOI Search in Google Scholar Back to article
Grigorescu BL, Săplăcan I, Bordea IR, Petrișor M, Coman O, Puiac CI, et al. Endogenous carboxyhemoglobin level variation in COVID-19 and bacterial sepsis. Microorganisms. 2022;10(2):305. doi:10.3390/microorganisms10020305.
Open DOI Search in Google Scholar Back to article
Dani C, Remaschi G, Monti N, Pratesi S. Carboxyhemoglobin as biomarker of late-onset sepsis in preterm infants. Eur J Pediatr. 2023;182(10):4523–4528. doi:10.1007/s00431-023-05120-y.
Open DOI Search in Google Scholar Back to article
Zhang L, Zheng Y, Xie R, Hong X, Zhou Z, Tu S, et al. Neutrophil-lymphocyte-monocyte ratio in predicting the risk of death in patients with severe pneumonia in the intensive care unit. Int J Clin Pract. 2025;2025:9274092. doi:10.1155/ijcp/9274092.
Open DOI Search in Google Scholar Back to article

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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)