{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T07:04:02Z","timestamp":1778569442273,"version":"3.51.4"},"reference-count":37,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The National key research and development plan","award":["2020YFC2005403"],"award-info":[{"award-number":["2020YFC2005403"]}]},{"name":"2021 Capital General Practice Research Project","award":["21QK08"],"award-info":[{"award-number":["21QK08"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exploring the value of the neutrophil\/lymphocyte ratio (NLR) as a potential supportive marker in community-acquired bloodstream infection in elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>By reviewing the data of inpatients in Xuanwu Hospital of Capital Medical University from January 2012 to December 2021, a total of 58 elderly patients with community-acquired bloodstream infection and 174 inpatients without infection during the same period, matched for age, sex, and concomitant diseases, were included. Clinical data were collected and analyzed statistically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were no significant differences in age, sex, and concomitant diseases between the infected and non-infected groups. Multivariate regression analysis showed that only increased NLR among leukocyte indexes was a risk factor for bloodstream infections. The sensitivity, specificity, and area under the curve (AUC) of increased NLR to support the diagnosis of community-acquired bloodstream infections in the elderly were 0.72, 0.99, and 0.95; the optimal cut-off value is 8.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The increase in NLR was superior to the rise of traditional white blood cell and neutrophil counts. Thus, NLR can be used as an indication for the early diagnosis of community-acquired bloodstream infection in the elderly. The optimal cutoff value of NLR for supporting the diagnosis of community-acquired bloodstream infections in elderly patients was determined to be 8.0. When NLR exceeds this threshold (&gt; 8.0), it serves as a clinical alert for community physicians, indicating a significantly elevated probability of elderly patients developing community-acquired bloodstream infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.20449","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:48:20Z","timestamp":1765183700000},"page":"e20449","source":"Crossref","is-referenced-by-count":1,"title":["Neutrophil-to-lymphocyte ratio: a potential supportive marker for elderly community-acquired bloodstream infections\u2014a retrospective study"],"prefix":"10.7717","volume":"13","author":[{"given":"Peijuan","family":"Li","sequence":"first","affiliation":[{"name":"General Practice Ward\/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiulin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Minzu Central Health Center, Haoba Town, Junlian County, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun","family":"Chen","sequence":"additional","affiliation":[{"name":"General Department, Health Center, Jiangan Town, Jiangan County, Yibin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianqian","family":"Pei","sequence":"additional","affiliation":[{"name":"Department of General Practice, Aerospace Center Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengxi","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunmei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4443","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"issue":"4","key":"10.7717\/peerj.20449\/ref-1","first-page":"238","article-title":"Relationship between age and peripheral white blood cell count in patients with sepsis","volume":"2","author":"Aminzadeh","year":"2011","journal-title":"International Journal of Preventive Medicine"},{"issue":"10","key":"10.7717\/peerj.20449\/ref-2","doi-asserted-by":"publisher","first-page":"2292","DOI":"10.7754\/Clin.Lab.2021.210133","article-title":"The role of the NLR and PLR in urinary tract infection","volume":"67","author":"Asik","year":"2021","journal-title":"Clinical Laboratory"},{"issue":"2","key":"10.7717\/peerj.20449\/ref-3","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.bpa.2013.06.010","article-title":"Monitoring infection: from blood culture to polymerase chain reaction (PCR)","volume":"27","author":"Book","year":"2013","journal-title":"Best Practice & Research: Clinical Anaesthesiology"},{"issue":"7","key":"10.7717\/peerj.20449\/ref-4","doi-asserted-by":"publisher","first-page":"3636","DOI":"10.3390\/ijms23073636","article-title":"Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases","volume":"23","author":"Buonacera","year":"2022","journal-title":"International Journal of Molecular Sciences"},{"issue":"8","key":"10.7717\/peerj.20449\/ref-5","doi-asserted-by":"publisher","first-page":"1796","DOI":"10.1111\/jgs.14894","article-title":"Neutrophil-To-Lymphocyte ratio: an emerging marker predicting prognosis in elderly adults with community-acquired pneumonia","volume":"65","author":"Cataudella","year":"2017","journal-title":"Journal of the American Geriatrics Society"},{"issue":"1","key":"10.7717\/peerj.20449\/ref-6","doi-asserted-by":"publisher","first-page":"176","DOI":"10.3904\/kjim.2016.119","article-title":"Clinical value of procalcitonin for suspected nosocomial bloodstream infection","volume":"33","author":"Cha","year":"2018","journal-title":"Korean Journal of Internal Medicine"},{"issue":"3","key":"10.7717\/peerj.20449\/ref-7","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1093\/ageing\/20.3.193","article-title":"The febrile response to mild infections in elderly hospital inpatients","volume":"20","author":"Darowski","year":"1991","journal-title":"Age and Ageing"},{"issue":"5","key":"10.7717\/peerj.20449\/ref-8","doi-asserted-by":"publisher","first-page":"R192","DOI":"10.1186\/cc9309","article-title":"Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit","volume":"14","author":"De\u00a0Jager","year":"2010","journal-title":"Critical Care"},{"issue":"10","key":"10.7717\/peerj.20449\/ref-9","doi-asserted-by":"publisher","first-page":"e46561","DOI":"10.1371\/journal.pone.0046561","article-title":"The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia","volume":"7","author":"De\u00a0Jager","year":"2012","journal-title":"PLOS ONE"},{"issue":"11","key":"10.7717\/peerj.20449\/ref-10","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Medicine"},{"issue":"1","key":"10.7717\/peerj.20449\/ref-11","doi-asserted-by":"publisher","first-page":"e22016","DOI":"10.1002\/jcla.22016","article-title":"Common laboratory parameters for differentiating between community-acquired and healthcare-associated pneumonia","volume":"31","author":"Farah","year":"2017","journal-title":"Journal of Clinical Laboratory Analysis"},{"issue":"Suppl 1","key":"10.7717\/peerj.20449\/ref-12","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.21037\/jtd.2019.12.63","article-title":"The complete blood count to diagnose septic shock","volume":"12","author":"Farkas","year":"2020","journal-title":"Journal of Thoracic Disease"},{"issue":"9","key":"10.7717\/peerj.20449\/ref-13","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.3390\/diagnostics12092033","article-title":"Diagnostic performance of neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, platelet to lymphocyte ratio, and platelet to mean platelet volume ratio in periprosthetic hip and knee infections: a systematic review and meta-analysis","volume":"12","author":"Festa","year":"2022","journal-title":"Diagnostics"},{"issue":"2","key":"10.7717\/peerj.20449\/ref-14","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1136\/thoraxjnl-2018-212826","article-title":"Neutrophils in community-acquired pneumonia: parallels in dysfunction at the extremes of age","volume":"75","author":"Grudzinska","year":"2020","journal-title":"Thorax"},{"issue":"6","key":"10.7717\/peerj.20449\/ref-15","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1111\/j.1445-5994.2006.01076.x","article-title":"Profound lymphopenia and bacteraemia","volume":"36","author":"Hawkins","year":"2006","journal-title":"Internal Medicine Journal"},{"key":"10.7717\/peerj.20449\/ref-16","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.arr.2017.03.008","article-title":"Aging and cancer: the role of macrophages and neutrophils","volume":"36","author":"Jackaman","year":"2017","journal-title":"Ageing Research Reviews"},{"issue":"2","key":"10.7717\/peerj.20449\/ref-17","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1111\/jgs.12634","article-title":"Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults","volume":"62","author":"Kaye","year":"2014","journal-title":"Journal of the American Geriatrics Society"},{"key":"10.7717\/peerj.20449\/ref-18","doi-asserted-by":"publisher","first-page":"1983455","DOI":"10.1155\/2022\/1983455","article-title":"The neutrophil to lymphocyte ratio in poststroke infection: a systematic review and meta-analysis","volume":"2022","author":"Khanzadeh","year":"2022","journal-title":"Disease Markers"},{"issue":"1","key":"10.7717\/peerj.20449\/ref-19","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s12887-025-05402-4","article-title":"Exploring the clinical value of procalcitonin, c-reactive protein, white blood cell count, and neutrophil-to-lymphocyte ratio in the early diagnosis of bloodstream infections in children","volume":"25","author":"Li","year":"2025","journal-title":"BMC Pediatrics"},{"key":"10.7717\/peerj.20449\/ref-20","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1672-9455.2020.04.019","article-title":"Clinical characteristics and etiological analysis of adult bloodstream infections from 2016 to 2017","author":"Liu","year":"2018","journal-title":"Laboratory Medicine and Clinical"},{"issue":"7","key":"10.7717\/peerj.20449\/ref-21","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1136\/emermed-2014-204071","article-title":"Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department","volume":"32","author":"Lowsby","year":"2015","journal-title":"Emergency Medicine Journal"},{"issue":"4","key":"10.7717\/peerj.20449\/ref-22","doi-asserted-by":"publisher","first-page":"271","DOI":"10.4103\/jets.Jets_72_17","article-title":"The eminence of neutrophil-lymphocyte count ratio in predicting bacteremia for community-acquired infections at an emergency medicine department in a tertiary care setting","volume":"11","author":"Manohar","year":"2018","journal-title":"Journal of Emergencies, Trauma, and Shock"},{"issue":"5","key":"10.7717\/peerj.20449\/ref-23","doi-asserted-by":"publisher","first-page":"314","DOI":"10.3760\/j:issn:0376-2491.2001.05.027","article-title":"Diagnostic criteria for nosocomial infections (Trial)","volume":"81","author":"Ministry of Health of the People\u2019s Republic\u00a0of China","year":"2001","journal-title":"Chinese Medical Journal"},{"issue":"5","key":"10.7717\/peerj.20449\/ref-24","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1586\/14737159.2015.1029459","article-title":"Emerging commercial molecular tests for the diagnosis of bloodstream infection","volume":"15","author":"Mwaigwisya","year":"2015","journal-title":"Expert Review of Molecular Diagnostics"},{"issue":"1","key":"10.7717\/peerj.20449\/ref-25","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1086\/313896","article-title":"Fever in the elderly","volume":"31","author":"Norman","year":"2000","journal-title":"Clinical Infectious Diseases"},{"issue":"15","key":"10.7717\/peerj.20449\/ref-26","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.2217\/bmm-2018-0253","article-title":"Evaluation of neutrophil-lymphocyte ratio in predicting bloodstream infection","volume":"13","author":"Qu","year":"2019","journal-title":"Biomarkers in Medicine"},{"issue":"12","key":"10.7717\/peerj.20449\/ref-27","doi-asserted-by":"publisher","first-page":"4057","DOI":"10.3390\/jcm12124057","article-title":"Assessing humoral immuno-inflammatory pathways associated with respiratory failure in COVID-19 patients","volume":"12","author":"Regolo","year":"2023","journal-title":"Journal of Clinical Medicine"},{"issue":"8","key":"10.7717\/peerj.20449\/ref-28","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.3390\/jcm11082235","article-title":"Neutrophil-to-lymphocyte ratio (NLR) is a promising predictor of mortality and admission to intensive care unit of COVID-19 patients","volume":"11","author":"Regolo","year":"2022","journal-title":"Journal of Clinical Medicine"},{"issue":"3","key":"10.7717\/peerj.20449\/ref-29","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.jemermed.2010.05.038","article-title":"Inadequacy of temperature and white blood cell count in predicting bacteremia in patients with suspected infection","volume":"42","author":"Seigel","year":"2012","journal-title":"Journal of Emergency Medicine"},{"issue":"6","key":"10.7717\/peerj.20449\/ref-30","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1093\/ageing\/aft121","article-title":"Diagnostic accuracy of three different methods of temperature measurement in acutely ill geriatric patients","volume":"42","author":"Singler","year":"2013","journal-title":"Age and Ageing"},{"issue":"8","key":"10.7717\/peerj.20449\/ref-31","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.it.2010.05.006","article-title":"Neutrophil kinetics in health and disease","volume":"31","author":"Summers","year":"2010","journal-title":"Trends in Immunology"},{"key":"10.7717\/peerj.20449\/ref-32","doi-asserted-by":"publisher","first-page":"93","DOI":"10.12122\/j.issn.1673-4254.2019.01.15","article-title":"Analysis of related factors for the severity of urosepsis","volume":"39","author":"Tan","year":"2019","journal-title":"Journal of Southern Medical University"},{"issue":"24","key":"10.7717\/peerj.20449\/ref-33","doi-asserted-by":"publisher","first-page":"4","DOI":"10.12056\/j.issn.1006-2785.2020.42.24.2019-3661","article-title":"The predictive value of indicators such as the neutrophil-to-lymphocyte ratio for elderly patients with febrile urinary tract infection complicated with bloodstream infection","volume":"42","author":"Wang","year":"2020","journal-title":"Zhejiang Medicine Journal"},{"issue":"5","key":"10.7717\/peerj.20449\/ref-34","doi-asserted-by":"publisher","first-page":"365","DOI":"10.3760\/cma.j.issn.0376-2491.2019.05.009","article-title":"The diagnostic and predictive value of white blood cells, procalcitonin and high-sensitivity C-reactive protein in bloodstream infections in extremely elderly and critically ill patients","volume":"99","author":"Xia","year":"2019","journal-title":"National Medical Journal of China"},{"issue":"003","key":"10.7717\/peerj.20449\/ref-35","doi-asserted-by":"publisher","first-page":"304","DOI":"10.3969\/j.issn.1671-167X.2010.03.013","article-title":"Systematic review and meta-analysis of in-hospital mortality rate of bloodstream infections in China","volume":"42","author":"Yang","year":"2010","journal-title":"Journal of Peking University (Medical Science Edition)"},{"issue":"7","key":"10.7717\/peerj.20449\/ref-36","doi-asserted-by":"publisher","first-page":"474","DOI":"10.4149\/bll_2021_078","article-title":"Neutrophil-to-lymphocyte ratio, past, present and future perspectives","volume":"122","author":"Zahorec","year":"2021","journal-title":"Bratislavske Lekarske Listy"},{"key":"10.7717\/peerj.20449\/ref-37","doi-asserted-by":"publisher","first-page":"47","DOI":"10.19368\/j.cnki.2096-1782.2022.08.047","article-title":"Analysis of the clinical characteristics of Staphylococcus aureus bloodstream infection and its prognostic influencing factors","volume":"7","author":"Zhang","year":"2022","journal-title":"Systems Medicine"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/20449.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20449.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20449.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20449.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:48:37Z","timestamp":1765183717000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/20449"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":37,"alternative-id":["10.7717\/peerj.20449"],"URL":"https:\/\/doi.org\/10.7717\/peerj.20449","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]},"article-number":"e20449"}}