{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T01:53:04Z","timestamp":1778723584090,"version":"3.51.4"},"reference-count":49,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T00:00:00Z","timestamp":1671753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Oradea"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles of the neutrophil-to-lymphocyte (NLR), derived-NRL (d-NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-C-reactive protein (LCR) ratios in predicting the progression to septic shock and death. Materials and Methods: A retrospective analysis of a consecutive series of ninety COVID-19 patients with prolonged hospitalization (exceeding 15 days) admitted to the ICU was conducted. The prevalence of culture-proven HAIs throughout their hospital stays was documented. NLR, dNLR, PLR, and LCR were recorded on admission, day 7, and day 14 to assess their discriminative prowess for detecting further progression to septic shock or death. Results: The prevalence of HAIs was 76.6%, 50% of patients met the criteria for septic shock, and 50% died. The median time to the first positive culture was 13.5 days and 20.5 days for developing septic shock. Mechanical ventilation was a key contributing factor to HAI, septic shock, and mortality. On admission and day 7 NLR, dNLR, PLR, and LCR values had no prognostic relevance for events occurring late during hospitalization. However, day-14 NLR, dNLR, and PLR were independent predictors for progression to septic shock and mortality and have shown good discriminative capabilities. The AUCs for septic shock were 0.762, 0.764, and 0.716, while the values for predicting in-hospital death were 0.782, 0.778, and 0.758, respectively. Conclusions: NLR, dNLR, and PLR are quick, easy-to-use, cheap, effective biomarkers for the detection of a more severe disease course, of the late development of HAIs, and of the risk of death in critically ill patients requiring a prolonged ICU stay.<\/jats:p>","DOI":"10.3390\/medicina59010032","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T04:40:39Z","timestamp":1672116039000},"page":"32","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay"],"prefix":"10.3390","volume":"59","author":[{"given":"Ioana Denisa","family":"Boto\u0219","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Panti\u0219","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7798-0762","authenticated-orcid":false,"given":"Constantin","family":"Bodolea","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania"},{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrada","family":"Nemes","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania"},{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Cri\u0219an","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Internal Medicine, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2656-3234","authenticated-orcid":false,"given":"Lucre\u021bia","family":"Avram","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Internal Medicine, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel Ovidiu","family":"Negr\u0103u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana Elisabeta","family":"Hiri\u0219c\u0103u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-8630","authenticated-orcid":false,"given":"Rare\u0219","family":"Cr\u0103ciun","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Gastroenterology Clinic, \u201cProf. Dr. O. Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cosmin Ioan","family":"Puia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania"},{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Surgery, \u201cProf. Dr. O. Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"key":"ref_1","first-page":"100227","article-title":"Boosters Reduce In-Hospital Mortality in Patients with COVID-19: An Observational Cohort Analysis","volume":"8","author":"Mielke","year":"2022","journal-title":"Lancet Reg. 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