ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1599592
This article is part of the Research TopicInfections in the Intensive Care Unit - Volume IIIView all 17 articles
Elevated NLR and PCT Levels and Reduced GCS Score Predict 90-Day Mortality in Heatstroke: Findings from a 13-Year Retrospective Cohort Study
Provisionally accepted
- 1Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- 2Department of Medical Intensive Care Unit, General Hospital of Southern Theater Command of PLA, Guangzhou, China
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Background and objective: Heatstroke is the most severe heat-related illness and is associated with high mortality rate. Inflammation and immune dysfunction are considered the key pathophysiological processes of heatstroke. The neutrophil-to-lymphocyte ratio (NLR) can reflect the states of innate and adaptive immune systems. The aim of the present study was to explore the predictive role of the NLR in heatstroke patients.: This single-center retrospective cohort study included all patients with exertional-heatstroke (EHS) admitted to the intensive-care-unit (ICU) of the General Hospital of Southern Theater Command of PLA from June 2009 to May 2022. The dynamic changes in the main immune cell counts and ratios were recorded. Results: A total of 232 patients were enrolled. Survivors had decreased NLRs 24 hours after admission, while nonsurvivors had continuously increased NLRs after admission. The AUC for the 24-hour NLR was 0.928, with a cutoff of 11.981. The patients were divided into NLR-high (NLR > 11) and NLR-low (NLR ≤11) groups based on their 24-hour NLRs.Patients in the NLR-high group had increased 90-day mortality. According to the multivariate analysis, an increased PCT level and decreased GCS score were independent risk factors for death in heatstroke patients with an NLR over 11, with odds ratios of 1.0999 (95% CI: 1.0050-1.2038, P value: 0.03863) and 0.6836 (95% CI: 0.5246 -0.8908, P value: 0.00486), respectively.Conclusions: An NLR greater than 11 in the early phase could be an independent predictor of prognosis in heatstroke patients, and an increased PCT level and decreased GCS score were risk factors for a poor prognosis.
Keywords: heatstroke, immune disorder, Neutrophil to lymphocyte ratio, PCT, GCS
Received: 25 Mar 2025; Accepted: 12 Jun 2025.
Copyright: © 2025 Guo, Ji, Ouyang, Wang, Jia and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhifeng Liu, Department of Medical Intensive Care Unit, General Hospital of Southern Theater Command of PLA, Guangzhou, China
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