Neutrophil-to-Lymphocyte Ratio Cut-off of > 10,75 as a Predictor of Mortality in Adult Patients with Bacterial Meningitis at Prof. Ngoerah General Hospital

Wandy Margo; Ni M Susilawathi; Anak AAP Laksmidewi; Ketut Widyastuti; I W Widyantara; Anak AR Sudewi

doi:10.28932/jmh.v8i1.11841

Authors

Wandy Margo Neurology Department, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Ni M Susilawathi Neurology Department, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Anak AAP Laksmidewi Neurology Department, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Ketut Widyastuti Neurology Department, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
I W Widyantara Neurology Department, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Anak AR Sudewi Neurology Department, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia

DOI:

https://doi.org/10.28932/jmh.v8i1.11841

Keywords:

NLR, meningitis, bacterial meningitis, mortality

Abstract

Pathogenic microorganisms of Mycobacterium tuberculosis cause bacterial meningitis. One in six patients with bacterial meningitis dies, according to WHO (2023). Inflammatory marker neutrophil-lymphocyte ratio (NLR) is easy to measure and inexpensive. The objective of this investigation is to validate NLR >10,75 as a prognostic indicator of mortality in adult patients with bacterial meningitis at Prof. Ngoerah General Hospital. This retrospective cohort observational analytic analysis included 156 patients treated from March 2021 to October 2024. Chi-square bivariate testing and logistic regression using SPSS IBM version 30 will be performed on this research data. After statistical analysis, the research subjects were separated into high and low NLR groups based on ROC of 10.75 and AUC of 79.8%. A study found that NLR >10.75 increases mortality risk in adult patients with bacterial meningitis by 2.842, with a 95% Confidence Interval of 1.871-4.317 and a p-value of <0.001. Bivariate and multivariate analyses indicated that sex, cerebrospinal fluid glucose levels, and NLR significantly affect mortality from bacterial meningitis. This study demonstrated that an NLR value exceeding 10.75 is a predictor of mortality in adult patients with bacterial meningitis at Prof. Ngoerah General Hospital.

Downloads

Download data is not yet available.

References

WHO. World Health Organization. 2025 [Cited 2025 May 18]. Meningitis. Available from: https://www.who.int/news-room/fact-sheets/detail/meningitis

Wunrow HY, Bender RG, Vongpradith A, Sirota SB, Swetschinski LR, Novotney A, et al. Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2023;22(8):685–711.

Setiawan WH, Sudewi AAR, Susilawathi NM. Karakteristik Mortalitas Pasien Meningitis yang Dirawat di RSUP Sanglah Denpasar Bulan Juli 2013 - Juli 2014 [Internet]. Universitas Udayana. Denpasar; 2014 [Cited 2025 May 18]. Available from: https://repositori.unud.ac.id/protected/storage/upload/repositori/e194062ac277437874428b80f68c4d1f.pdf

Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci. 2022;23(7):3636.

Widjaja H, Rusmawatiningtyas D, Makrufardi F, Arguni E. Neutrophil lymphocyte ratio as predictor of mortality in pediatric patients with bacterial meningitis: a retrospective cohort study. Ann Med Surg (Lond). 2022;73:103156.

Dahlan MS. Besar sampel dan cara pengambilan sampel dalam penelitian kedokteran dan kesehatan. 3rd ed. Salemba Medika; 2010.

Karanika M, Vasilopoulou VA, Katsioulis AT, Papastergiou P, Theodoridou MN, Hadjichristodoulou CS. Diagnostic Clinical and Laboratory Findings in Response to Predetermining Bacterial Pathogen: Data from the Meningitis Registry. PLoS One. 2009;4(7):1.

Giede-Jeppe A, Atay S, Koehn J, Mrochen A, Luecking H, Hoelter P, et al. Neutrophil-to-lymphocyte ratio is associated with increased cerebral blood flow velocity in acute bacterial meningitis. Sci Rep. 2021 Dec 1;11(1).

Varatharaj A, Galea I. The blood-brain barrier in systemic inflammation. Brain Behav Immun. 2017;60:1–12.

Hoffmann O, Rung O, Held J, Boettcher C, Prokop S, Stenzel W, et al. Lymphocytes modulate innate immune responses and neuronal damage in experimental meningitis. Infect Immun. 2015;83(1):259–67.

van de Beek D, de Gans J, Tunkel AR, Wijdicks EFM. Community-Acquired Bacterial Meningitis in Adults. New England Journal of Medicine. 2006;354(1):44–53.

Varatharaj A, Galea I. The blood-brain barrier in systemic inflammation. Brain Behav Immun. 2017 Feb;60:1–12.

Hsieh DY, Lai YR, Lien CY, Chang WN, Huang CC, Cheng BC, et al. Sex-based differences in bacterial meningitis in adults: Epidemiology, clinical features, and therapeutic outcomes. J Infect Public Health. 2021;14(9):1218–25.

Jaillon S, Berthenet K, Garlanda C. Sexual dimorphism in innate immunity. Clin Rev Allergy Immunol. 2019;56(3):308-21

vom Steeg LG, Klein SL. Sex matters in infectious disease pathogenesis. PLoS Pathog. 2016;12(2):e1005374.

Furman D, Hejblum BP, Simon N, Jojic V, Dekker CL, Thiébaut R, et al. Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination. Proceedings of the National Academy of Sciences. 2014;111(2):869–74.

Akaishi T, Tarasawa K, Fushimi K, Yaegashi N, Aoki M, Fujimori K. Demographic profiles and risk factors for mortality in acute meningitis: a nationwide population-based observational study. Acute Med Surg. 2024;11(1):e00197.

Makowiecki M, Paciorek M, Bednarska A, Krogulec D, Porowski D, Bursa D, et al. Factors Associated with In-Hospital Mortality in Adult Patients with Bacterial Meningitis. J Clin Med. 2024;13(24).

Okparasta A, Susan D. Characteristics, Patterns of Pathogens, and Antibiotics Resistance of Bacterial Meningitis at RSUP dr. Mohammad Hoesin Palembang. Jurnal Kedokteran dan Kesehatan: Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya. 2020;7(3):215–26.

Tabatabaee S, Almasi-Dooghaee M, Gandomi-Mohammadabadi A, Tabatabaei S. Nonconvulsive status epilepticus as an unusual presentation of tuberculous meningoencephalitis: A case report. Clin Case Rep. 2023;11(2).

Shrikanth V, Salazar L, Khoury N, Wootton S, Hasbun R. Hypoglycorrhachia in adults with community-acquired meningitis: Etiologies and prognostic significance. Int J Infect Dis. 2015;39:39-43. .

Arismunandar M. Analisis Faktor Prediktor Kematian pada Pasien Meningitis Dewasa di RSUP PROF. Dr. I.G.N.G. Ngoerah. [Denpasar]: Universitas Udayana; 2024.

Susilawathi NM, Tarini NMA, Fatmawati NND, Mayura PIB, Suryapraba AAA, Subrata M, et al. Streptococcus suis–associated meningitis, Bali, Indonesia, 2014–2017. Emerg Infect Dis. 2019;25(12):2235-42.

Torok ME. Tuberculous meningitis: advances in diagnosis and treatment. Br Med Bull. 2015;113(1):117–31.