Predictive Role of Neutrophil-to-Lymphocyte Ratio and Serum Creatinine in the Early Detection of Sepsis-Related Organ Dysfunction

Background and aim Sepsis is a major cause of morbidity and mortality worldwide. Early identification of patients at risk of organ dysfunction is important for timely treatment and improved outcomes. Although neutrophil-to-lymphocyte ratio (NLR) and serum creatinine are not specific to sepsis and may be elevated in other inflammatory or renal conditions, they are simple and readily available laboratory markers that may help identify high-risk patients at hospital admission. The aim of this study was to evaluate the predictive role of NLR and serum creatinine in the early detection of sepsis-related organ dysfunction. Methods This cross-sectional study was conducted at Mekran Medical College, Turbat, Pakistan, from January 2025 to June 2025. A total of 384 adult patients with sepsis were enrolled through consecutive sampling. Demographic and clinical data were collected at hospital admission. CBCs and serum creatinine levels were measured at admission, and NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed to evaluate the association and predictive performance of the studied markers. Results Among 384 patients, 142 (37%) developed sepsis-related organ dysfunction. Patients with organ dysfunction had significantly higher NLR (12.4 ± 4.6 vs. 5.4 ± 2.2, p < 0.001) and serum creatinine levels (2.11 ± 0.89 vs. 1.09 ± 0.34 mg/dL, p < 0.001). ROC analysis showed that NLR had an area under the curve (AUC) of 0.868, while serum creatinine had an AUC of 0.831. Multivariable logistic regression demonstrated that NLR (adjusted OR = 1.28, 95% CI: 1.20-1.36, p < 0.001) and serum creatinine (adjusted OR = 3.04, 95% CI: 2.06-4.50, p < 0.001) were independent predictors of organ dysfunction, although the wider confidence interval for serum creatinine suggests lower precision of the estimated effect. Conclusions Elevated NLR and serum creatinine were significantly associated with sepsis-related organ dysfunction at hospital admission. Both markers may serve as simple, inexpensive, and readily available tools for early risk assessment of septic patients. However, the cross-sectional design limits causal inference, and prospective studies are needed to confirm their predictive value over time.