Skip to main content Skip to main navigation menu Skip to site footer

Perbedaan nilai Neutrophil Lymphocyte Ratio (NLR) terhadap pemeriksaan kultur darah dalam mendiagnosis sepsis pada pasien peritonitis di RSUP Sanglah, Bali, Indonesia


Background: Sepsis is a leading cause of death worldwide. A delayed or missed diagnosis of sepsis could increase its morbidity and mortality. The abdomen is the most common source of sepsis, which known as peritonitis-induced-sepsis. Peritonitis leads to an inflammatory and anti-inflammatory response. This study aims to elaborate on the role of Neutrophil Lymphocyte Ratio (NLR) as an easy, fast and inexpensive infection marker compared to blood culture, which known as the gold standard of sepsis in peritonitis patients. 

Methods: This is a diagnostic study which combined secondary data taken at Sanglah Hospital Medical Record Department and new cases of generalized peritonitis patients with sepsis who came to Surgical Emergency Unit of Sanglah Hospital as the subjects. A total of 86 subjects, complete blood count analysis was done to calculate NLR. Besides, 2-sided blood culture was tested to see whether the results were positive or negative. Data were analyzed using Stata/SE version 12.1

Results: We found that sensitivity of NLR compared to blood culture was 80% (CI:63.1-91.6), with specificity of 88.2% (CI:76.1-95.6), positive predictive value of 82.4% (CI:65.5-93.2), negative predictive value of 86.5% (74.2-94.4), accuracy of 84.9% and likelihood ratio (LR) positive value of 6.8>1. Our results showed that NLR has an enormous value in predicting the occurrence of sepsis in patients with generalized peritonitis. 

Conclusion: NLR can be used as a screening tool for sepsis in generalized peritonitis patients because it has better sensitivity and accuracy, but it has to confirmed by blood culture as the gold standard.


Latar belakang: Sepsis merupakan penyebab kematian diseluruh dunia. Keterlambatan atau kesalahan dalam mendiagnosis dapat menyebabkan peningkatkan morbiditas dan mortalitas. Abdomen merupakan sumber penyebab paling sering terjadinya sepsis yang disebut dengan sepsis diinduksi peritonitis (peritonitis-induced sepsis). Penelitian ini bertujuan untuk menguji kemampuan Neutrophil Lymphocyte Ratio (NLR) sebagai marker infeksi yang mudah, cepat dan murah dibandingkan kultur darah yang merupakan standar baku dalam mendiagnosis sepsis pada pasien peritonitis.

Metode: Rancangan penelitan yang digunakan dalam penelitian ini adalah uji diagnostik dengan subjek penelitian  merupakan gabungan antara data sekunder yang diambil di Instalasi Rekam Medis RSUP Sanglah serta identifikasi kasus baru yaitu pasien sepsis pada peritonitis generalisata yang datang ke IRD Bedah RSUP Sanglah sehingga jumlah total sampel 86 orang. Pasien kemudian diambil darah lengkap untuk nilai NLR dan kultur darah 2 sisi apakah hasilnya positif atau negatif. Data dianalisis menggunakan Stata/SE versi 12.1

Hasil:   Dari penelitian ini didapatkan sensitifitas NLR dibandingkan dengan kultur darah adalah sebesar 80% (CI: 63,1-91,6) dengan spesifitas 88,2% (CI: 76,1-95,6), nilai prediktif positif 82,4% (CI: 65,5-93,2), nilai prediktif negatif 86,5% (CI: 74,2-94,4) dan akurasi 84,9%, serta nilai likelihood ratio (LR) positif didapatkan 6,8>1. NLR mempunyai nilai yang besar dalam meprediksi terjadinya sepsis pada pasien peritonitis generalisata.

Simpulan: NLR dapat digunakan sebagai skrinning pasien sepsis pada peritonitis generalisata karena memiliki sensistifitas dan akurasi yang lebih baik tetapi tetap dikonfirmasi dengan kultur darah sebagai standar baku.


  1. Palmu A. Peritoniitti ja intra-abdominaaliset absessit [Peritonitis and intra-abdominal abscess]. Duodecim. 1979;95(23):1608–1616.
  2. Mureșan MG, Balmoș IA, Badea I, Santini A. Abdominal Sepsis: An Update. J Crit Care Med (Targu Mures). 2018;4(4):120–125.
  3. Leppäniemi A, Kimball EJ, De Laet I, Malbrain ML, Balogh ZJ, De Waele JJ. Management of abdominal sepsis--a paradigm shift?. Anaesthesiol Intensive Ther. 2015;47(4):400–408.
  4. Khan PS, Dar LA, Hayat H. Predictors of mortality and morbidity in peritonitis in a developing country. Ulus Cerrahi Derg. 2013;29(3):124–130.
  5. Riché F, Gayat E, Barthélémy R, Le Dorze M, Matéo J, Payen D. Reversal of neutrophil-to-lymphocyte count ratio in early versus late death from septic shock. Crit Care. 2015;19:439.
  6. Sandquist M, Wong HR. Biomarkers of sepsis and their potential value in diagnosis, prognosis and treatment. Expert Rev Clin Immunol. 2014;10(10):1349–1356.
  7. Vincent JL, Beumier M. Diagnostic and prognostic markers in sepsis. Expert Rev Anti Infect Ther. 2013;11(3):265–275.
  8. Sheldon IM. Detection of Pathogens in Blood for Diagnosis of Sepsis and Beyond. EBioMedicine. 2016;9:13–14.
  9. Fan SL, Miller NS, Lee J, Remick DG. Diagnosing sepsis - The role of laboratory medicine. Clin Chim Acta. 2016;460:203–210.
  10. Shen XF, Cao K, Jiang JP, Guan WX, Du JF. Neutrophil dysregulation during sepsis: an overview and update. J Cell Mol Med. 2017;21(9):1687–1697.
  11. Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863–868.
  12. Savran Y, Megi T, Yilmaz B, Tokur ME, Ergan B, Yaka E, et al. Can neutrophil lymphocyte ratio predict disease severity and mortality in sepsis and septic shock Patients?. Act Medica Mediterranea. 2018;34(3):877-882.
  13. Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Patients with Sepsis: A Prospective Observational Study. Mediators Inflamm. 2016;2016:8191254.
  14. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840–851.
  15. Sartelli M, Catena F, Di Saverio S, et al. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014;9(1):22.
  16. Dilektasli E, Inaba K, Haltmeier T, et al. The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients. J Trauma Acute Care Surg. 2016;81(5):882–888.
  17. Núñez J, Núñez E, Bodí V, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol. 2008;101(6):747–752.
  18. Marshall JC. Intra-abdominal infections. Microbes Infect. 2004;6(11):1015–1025.
  19. Lopez N, Kobayashi L, Coimbra R. A Comprehensive review of abdominal infections. World J Emerg Surg. 2011;6:7.
  20. Riedel S, Melendez JH, An AT, Rosenbaum JE, Zenilman JM. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol. 2011;135(2):182–189.
  21. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011;9:107.
  22. Venet C, Zeni F, Viallon A, et al. Endotoxaemia in patients with severe sepsis or septic shock. Intensive Care Med. 2000;26(5):538–544.
  23. Kaushik R, Gupta M, Sharma M, et al. Diagnostic and Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Early and Late Phase of Sepsis. Indian J Crit Care Med. 2018;22(9):660–663.
  24. Haloho AB, Irwanto FH, Theodorus, Gusnaintin R. Uji Diagnostik Rasio Neutrofil-Limfosit dibanding dengan Procalcitonin sebagai Biomarker Infeksi Bakteri Pasien Sepsis. Anesthesia & Critical Care. 2017;35:121-31.
  25. Rosales C, Demaurex N, Lowell CA, Uribe-Querol E. Neutrophils: Their Role in Innate and Adaptive Immunity. J Immunol Res. 2016;2016:1469780.
  26. Liew PX, Kubes P. The Neutrophil's Role During Health and Disease. Physiol Rev. 2019;99(2):1223–1248.
  27. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5–14.
  28. Sonawane VB, Mehkarkar N, Gaikwad S, Kadam N. Comparison between sepsis markers and blood culture in diagnosis of neonatal sepsis: a prospective study. Int J Res Med Sci. 2017;5(4):1662-6.

How to Cite

Sudiartha, I. P. G., Wiargitha, I. K., & Mahadewa, T. G. B. (2020). Perbedaan nilai Neutrophil Lymphocyte Ratio (NLR) terhadap pemeriksaan kultur darah dalam mendiagnosis sepsis pada pasien peritonitis di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis, 11(1), 165–171.




Search Panel

I Putu Gede Sudiartha
Google Scholar
ISM Journal

I Ketut Wiargitha
Google Scholar
ISM Journal

Tjokorda Gde Bagus Mahadewa
Google Scholar
ISM Journal