To evaluate the predictive value of Neutrophil To Lymphocyte Ratio (NLR) To Predict New Onset Atrial Fibrillation (NOAF) In Septic Shock

Introduction: Atrial Fibrillation (AF) is the commonest arrythmia in septic shock¹. It is common during first 72 hours of the septic shock^2,3. An exact cause of this is not known, although inflammation is the proposed cause by many. NLR is emerging as a new cost effective marker in various inflammatory  conditions including sepsis^4,5.

Objectives: We observed the NLR values on day 1, 3 and 5 of all patients admitted or who developed septic shock during their ICU stay. The day of onset, length of ICU stay, number of episodes and resolution of shock were observed.

Methods: 97 adult patients admitted in various intensive care units of King Edward Memorial Hospital, Pune, who had septic shock during their ICU stay, were included. Continuous ECG monitoring was done. NLR value >3.53 was considered as a positive value or test. (Normal value is 0.78 to 3.53)^1,6

Exclusion criteria: Neutropenia, immunosupression, pregnancy,  pre-existing AF or valvular heart disease and other causes of shock.

Results
Table 1: Sensitivity analysis of NLR
 

Table 2: AUC

Figure 1: ROC curve.

Conclusions: NLR  has a good sensitivity to predict NOAF  in septic shock but lacks specificity.The cut off value for NLR of 3.53 on day 3 has better predictive value for NOAF in septic shock than on day 1 and day 5.

I have done my medical graduation from BJ medical college, Pune,India. I have done my post graduate training in Anaethesiology. I have done my fellowship in critical care and currently working as a consultant in critical care medicine. I am also a post graduate teacher in critical care medicine. My interests-Antimicrobial stewardship, Hemodynamics, Echocardiography and Research.