Sepsis is a systemic inflammatory response syndrome caused by infection can lead to life threatening multi-organ dysfunction.~Septic shock causes circulatory and metabolic abnormalities, leading to increased mortality in hospitalized patients, especially in intensive care unit (ICU) patients.~Sepsis can affect the function and number of immune cells, including neutrophils, lymphocytes and monocytes.~Neutrophils play crucial roles in the innate cellular immune system. Early higher neutrophil counts correlated with increased sepsis severity.~In sepsis, lymphocytes decrease owing to the apoptosis mediated by innate response.~Reversily, number of neutrophils dramatically increase reflecting degree of inflammation.~The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker that can be obtained through blood routine tests, it is cost- effective and widely available, and it is beneficial to the early recognition of poor prognosis in septic patients.~Albumin is a molecule that is the most abundant protein in plasma. For a variety of physiological mechanisms, albumin has a variety of function, including serving as a major buffer, extracellular antioxidant, immune modulator, antidote and transporter in plasma.~Increased capillary leakage of albumin is one of the features of SIRS. This means that lower albumin levels correlate with severe systemic inflammation and organ failure.~Hypoxia and tissue hypo perfusion seen in sepsis play a key role on the development of multi-organ failure in septic patients.~Lactic acidosis is one of the best indicators of the insufficient perfusion or development of anaerobic metabolism during septic shock.~The inability of liver to metabolize lactate as a result of the deterioration of liver perfusion also increases lactate levels.~The measurement of blood lactate levels used to determine tissue hypoxia is rapid, inexpensive and easy.~Because lactate and albumin levels progress differently as the development of sepsis proceeds, a ratio between the two rather than analyzing lactate and albumin alone may be a new and perhaps better indicator for the patient's prognosis.
The aim of the study is to compare between neutrophil lymphocyte ratio and lactate albumin ratio as a predictor of morbidity and mortality in sepsis and septic shock patients.