***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction Septic shock is one of the most frequent causes of admission to the intensive care unit ( ICU ) and is associated with a poor prognosis . Early and late death in septic shock should be distinguished because they may involve different underlying mechanisms . In various conditions , the neutrophil-to-lymphocyte count ratio ( NLCR ) has been described as an easily measurable parameter to express injury severity . In the present study , we investigated whether the timing of death was related to a particular NLCR . Methods We conducted a prospect i ve , single-center , observational study that included consecutive septic shock patients . Severity scores , early ( before day 5 ) or late ( on or after day 5 of septic shock onset ) ICU mortality , and daily leukocyte counts were collected during the ICU stay . We assessed the association between leukocyte counts at admission and their evolution during the first 5 days with early or late death . The association between patient characteristics ( including cell counts ) and prognosis was estimated using Cox proportional cause-specific hazards models . Results The study included 130 patients who were diagnosed with abdominal ( n = 99 ) or extra-abdominal ( n = 31 ) septic shock . The median ( interquartile range ) NLCR was 12.5 ( 6.5–21.2 ) in survivors and 6.2 ( 3.7–12.6 ) in nonsurvivors ( p = 0.001 ) . The NLCR at admission was significantly lower in patients who died before day 5 than in survivors ( 5 [ 3.5–11.6 ] versus 12.5 [ 6.5–21.2 ] , respectively ; p = 0.01 ) . From day 1 to day 5 , an increased NLCR related to an increase in neutrophil count and a decrease in lymphocyte count was associated with late death ( + 34.8 % [ −8.2 to 305.4 ] versus −20 % [ −57.4 to 45.9 ] ; p = 0.003 ) . Those results were present in patients with abdominal origin sepsis as well as in those with extra-abdominal sepsis , who were analyzed separately . Conclusions In the present study , a reversed NLCR evolution was observed according to the timing of death . Septic shock patients at risk of early death had a low NLCR at admission , although late death was associated with an increased NLCR during the first 5 days Patients with sepsis have impaired host defenses that contribute to the lethality of the disorder . Recent work implicates lymphocyte apoptosis as a potential factor in the immunosuppression of sepsis . If lymphocyte apoptosis is an important mechanism , specific subsets of lymphocytes may be more vulnerable . A prospect i ve study of lymphocyte cell typing and apoptosis was conducted in spleens from 27 patients with sepsis and 25 patients with trauma . Spleens from 16 critically ill nonseptic ( 3 prospect i ve and 13 retrospective ) patients were also evaluated . Immunohistochemical staining showed a caspase-9-mediated profound progressive loss of B and CD4 T helper cells in sepsis . Interestingly , sepsis did not decrease CD8 T or NK cells . Although there was no overall effect on lymphocytes from critically ill nonseptic patients ( considered as a group ) , certain individual patients did exhibit significant loss of B and CD4 T cells . The loss of B and CD4 T cells in sepsis is especially significant because it occurs during life-threatening infection , a state in which massive lymphocyte clonal expansion should exist . Mitochondria-dependent lymphocyte apoptosis may contribute to the immunosuppression in sepsis by decreasing the number of immune effector cells . Similar loss of lymphocytes may be occurring in critically ill patients with other disorders Introduction The neutrophil-to-lymphocyte ratio ( NLR ) is a biological marker that has been shown to be associated with outcomes in patients with a number of different malignancies . The objective of this study was to assess the relationship between NLR and mortality in a population of adult critically ill patients . Methods We performed an observational cohort study of unselected intensive care unit ( ICU ) patients based on records in a large clinical data base . We computed individual patient NLR and categorized patients by quartile of this ratio . The association of NLR quartiles and 28-day mortality was assessed using multivariable logistic regression . Secondary outcomes included mortality in the ICU , in-hospital mortality and 1-year mortality . An a priori subgroup analysis of patients with versus without sepsis was performed to assess any differences in the relationship between the NLR and outcomes in these cohorts . Results A total of 5,056 patients were included . Their 28-day mortality rate was 19 % . The median age of the cohort was 65 years , and 47 % were female . The median NLR for the entire cohort was 8.9 ( interquartile range , 4.99 to 16.21 ) . Following multivariable adjustments , there was a stepwise increase in mortality with increasing quartiles of NLR ( first quartile : reference category ; second quartile odds ratio ( OR ) = 1.32 ; 95 % confidence interval ( CI ) , 1.03 to 1.71 ; third quartile OR = 1.43 ; 95 % CI , 1.12 to 1.83 ; 4th quartile OR = 1.71 ; 95 % CI , 1.35 to 2.16 ) . A similar stepwise relationship was identified in the subgroup of patients who presented without sepsis . The NLR was not associated with 28-day mortality in patients with sepsis . Increasing quartile of NLR was statistically significantly associated with secondary outcome . Conclusion The NLR is associated with outcomes in unselected critically ill patients . In patients with sepsis , there was no statistically significant relationship between NLR and mortality . Further investigation is required to increase underst and ing of the pathophysiology of this relationship and to vali date these findings with data collected prospect ively BACKGROUND The neutrophil-to-lymphocyte ratio is an independent predictor of worse prognosis in both infectious and cardiovascular disease . We hypothesized that an increased neutrophil-to-lymphocyte ratio at admission would predict in-hospital unfavourable outcomes in patients with infective endocarditis ( IE ) . METHODS We retrospectively analyzed clinical , laboratory , and echocardiographic data in a total of 121 consecutive adult patients ( 64 men ; mean age , 54.7 ± 14.2 years ) with definite IE . RESULTS Among all patients , the prespecified clinical outcomes were experienced in 46 patients ( 38 % ) . In-hospital mortality and central nervous system ( CNS ) events occurred in 29 ( 24 % ) and 21 patients ( 17 % ) , respectively . The neutrophil-to-lymphocyte ratio at admission was found to be significantly higher for either composite end point . On using multiple Cox regression analysis , vegetation size ≥ 10 mm , end-stage renal disease , Staphylococcus aureus infection , low hemoglobin level , increased C-reactive protein ( CRP ) level , and high neutrophil-to-lymphocyte ratio at admission emerged as independent predictors of in-hospital unfavourable outcomes . In the receiver operating characteristics ( ROC ) curve analysis , a neutrophil-to-lymphocyte ratio > 7.1 had 80 % sensitivity and 83 % specificity in predicting adverse outcomes . CONCLUSION High neutrophil-to-lymphocyte ratio at admission is an independent predictor of in-hospital mortality and CNS events in patients with IE . However , prospect i ve validation of these findings is required OBJECTIVE Infection with the bacterial pathogen Helicobacter pylori ( HP ) clearly results in chronic mucosal inflammation in the stomach and duodenum , which , in turn , might lead to abnormalities in gastroduodenal motility and sensitivity and is the most frequent cause of dyspepsia and peptic disease . Some studies have shown that there was a correlation between low- grade inflammation as C-reactive protein ( CRP ) and HP infection . The aim of this study was to investigate the relationship between the presence of gastritis due to HP infection and neutrophil/lymphocyte ratio ( NLR ) , a simple and reliable indicator of inflammation . DESIGN Fifty patients met the HP criteria and half of them have had severe symptoms and upper endoscopy showed atrophic gastritis , and fifty age- and sex-matched control subjects with gastritis without HP infection were included in this r and omized controlled trial . Patients were diagnosed to have HP according to the use of urea breath testing ( UBT ) and multiple biopsies .  NLR was calculated from complete blood count at the time of diagnosis and before initiating the treatment to all groups . RESULTS Patients with HP infection had significantly higher NLR compared to those without HP . Moreover , the patients with symptomatic HP and grade 4 gastritis had higher NLR than those asymptomatic with past history of peptic disease ( P 0.007 and P 0.068 , respectively ) . Although NLR increased as the severity of gastritis and HP symptoms increased ( r = 0.564 , P < 0.001 ) , Receiver operating characteristic ( ROC ) Curve analysis was performed . The cut-off level for NLR with optimal sensitivity and specificity was calculated as 1.82 ( area under curve [ AUC ] = 0.825 [ 0.753 - 0.884 ] , P < 0.001 ) . CONCLUSION The present study indicated , for the first time , a significant correlation between HP infection and inflammation on the basis of NLR , a simple and reliable indicator of inflammation . Furthermore , there is an increase in NLR as the severity of gastritis with HP increases . This elevated ratio gets normalized with treatment Lymphopenia and lymphoid depletion occur in adults dying of sepsis . Prolactin increases Bcl-2 expression , suppresses stress-induced lymphocyte apoptosis , and improves survival from experimental sepsis . We hypothesized that prolonged lymphopenia , lymphoid depletion , and hypoprolactinemia occur in children dying with sepsis and multiple organ failure ( MOF ) . Fifty-eight critically ill children with and 55 without MOF admitted to a university hospital pediatric intensive care unit were enrolled in a prospect i ve , longitudinal , observational clinical study .  Prolactin levels and absolute lymphocyte count were measured on days 1 , 3 , 7 , 14 , and 21 . Lymph node , thymus , and spleen autopsy specimens were examined for lymphoid depletion , with immunohistochemical staining for CD4 , CD20 , and CD21 and for lymphoid apoptosis . Prolonged lymphopenia ( absolute lymphocyte count < 1000 for > 7 days ) occurred only in children with MOF ( 29 vs 0 % , p < 0.05 ) and was associated independently with nosocomial infection ( odds ratio ( OR ) , 5.5 , 95 % confidence interval ( CI ) , 1.7–17 , p < 0.05 ) , death ( OR , 6.8 , 95 % CI , 1.3–34 , p < 0.05 ) , and splenic and lymph node hypocellularity ( OR , 42 , 95 % CI , 3.7–473 , p < 0.05 ) . Lymphocyte apoptosis and ante/postmortem infection were observed only in children with lymphoid depletion . Prolonged hypoprolactinemia  ( > 7 days ) was more common in children with MOF ( 17 vs 2 % , p < 0.05 ) and was associated independently with prolonged lymphopenia ( OR , 8.3 , 95 % CI , 2.1–33 , p < 0.05 ) and lymphoid depletion ( OR , 12.2 , 95 % CI , 2.2–65 , p < 0.05 ) . Prolonged lymphopenia and apoptosis-associated depletion of lymphoid organs play a role in nosocomial sepsis-related death in critically ill children . Prolonged hypoprolactinemia is a previously unrecognized risk factor for this syndrome Although the sensitivity and specificity of the Duke criteria for the diagnosis of infective endocarditis ( IE ) have been vali date d by investigators from Europe and the United States , several shortcomings of this schema remain . The Duke IE data base contains records collected prospect ively on > 800 cases of definite and possible IE since 1984 . Data bases on echocardiograms and on patients with Staphylococcus aureus bacteremia at Duke University Medical Center are also maintained . Analyses of these data bases , our experience with the Duke criteria in clinical practice , and analysis of the work of others have led us to propose the following modifications of the Duke schema . The category " possible IE " should be defined as having at least 1 major criterion and 1 minor criterion or 3 minor criteria . The minor criterion " echocardiogram consistent with IE but not meeting major criterion " should be eliminated , given the widespread use of transesophageal echocardiography ( TEE ) . Bacteremia due to S. aureus should be considered a major criterion , regardless of whether the infection is nosocomially acquired or whether a removable source of infection is present . Positive Q-fever serology should be changed to a major criterion Study Objective The neutrophil-lymphocyte count ratio ( NLCR ) has been identified as a predictor of bacteremia in medical emergencies . The aim of this study was to investigate the value of the NLCR in patients with community 
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Potential clinical utility was also demonstrated in pneumonia ( NLR ) , pertussis ( NLR ) , urinary tract infection ( NLR ) , diabetic foot infections ( NLR ) and Crimean Congo Haemorrhagic Fever ( PLR ) .
Longitudinal measurement of LMR during respiratory virus infection reflected symptoms and NLR during sepsis and bacteraemia predicted mortality .
Conclusions Peripheral blood leucocyte ratios are useful infection biomarkers , with the most evidence related to diagnosis of bacteraemia and influenza virus infection .