Analysis of the association of neutrophil-to-lymphocyte ratio, MPV-to-platelet ratio, and clinical risk factors for mortality in ICU patients with candidemia: a 10-year retrospective analysis

Abstract

Background Candidaemia is a leading cause of mortality in hospitalized patients. The determination of risk factors is necessary to predict mortality. We aimed to evaluate whether the neutrophil, lymphocyte, monocyte, and platelet counts; red blood cell distribution width (RDW), mean platelet volume (MPV), neutrophil/lymphocyte (N/L) and MPV/platelet count (MPV/plt) ratios, and other clinical characteristics are risk factors for mortality. Methods This study was retrospective and observational. Patients aged 18 years and older who were hospitalized in the intensive care unit between January 1, 2014, and January 1, 2024, who had Candida detected via blood culture, were included in the study. Demographic data, neutrophil, lymphocyte, monocyte, and platelet counts; RDW, MPV, N/L, and MPV/plt ratios, and clinical characteristics of patients were recorded in the patient form. Logistic regression analysis was used to identify independent risk factors. Results The mean age of the 468 patients was 64.26 +/- 15.9 years, and 204 (43.6%) were female. A total of 321 patients (68.6%) died. The most common comorbid disease was malignancy (n = 171, 36.5%), whereas 482 candidemia episodes were detected. Candida parapsilosis (n = 239, 49.6%) was the most frequently isolated strain. Diabetes mellitus, chronic obstructive pulmonary disease, malignancy, N/L, and MPV/plt ratios were found to be associated with mortality in univariate analysis, but none were found to be risk factors for mortality in multivariate regression analysis. Higher age, congestive heart failure (CHF), higher neutrophil count, RDW > 17.1 /%, low albumin level, low platelet count, lymphocyte count < 1000 /mm3, total parenteral nutrition (TPN), mechanical ventilation (MV), immunosuppressive drug use and Candida glabrata were independent risk factors for mortality. Conclusions Mortality remains high among ICU patients with candidemia. This ten-year analysis identified advanced age, CHF, elevated RDW, lymphopenia, thrombocytopenia, hypoalbuminemia, TPN, MV, immunosuppressive therapy, and candidemia caused by C. glabrata were identified as independent risk factors for mortality. Integrating haematological and clinical parameters in a risk stratification model may help to reduce mortality rates.