Systematic review, meta-analysis, and meta-regression of the association of serial leukocyte counts in critically ill patients and mortality
Authors' conclusion
A higher NLR count was associated with increased mortality throughout the first week of critical illness.
Study context
- Population
- Critically ill patients with immune cell counts on admission and within the subsequent week
- Participants
- 26,441 patients · 30 studies
- Comparison
- Immune cell counts in survivors vs non-survivors
- Outcome
- Which immune cell type (total leukocytes, neutrophils, lymphocytes or NLR) best predicted mortality
Pooled result
As reported in the abstract
NLR, survivors vs non-survivors
Survivors vs Non-survivorsMD (95% CI)P value
Days 0-1
−0.29(−0.45 to −0.12)
P = 0.001Days 2-4
−1.02(−1.57 to −0.48)
P < 0.001Days 5-7
−0.69(−1.00 to −0.38)
P < 0.001Further pooled results
Lymphocyte count
- Higher among survivors at equivalent time points
Meta-regression of NLR on illness severity (study mortality rate) · days 0-1
- MD decreases per 10% increase in mortality
- 0.13 (0.05, 0.20)
- P
- P = 0.001
- Not explained by severity at other time points
Meta-regression on underlying diagnosis
- Underlying diagnosis did not explain heterogeneity
Leukocyte counts and secondary infections
- Meta-analysis not possible; only 3 studies reported data
Original publication
Systematic review, meta-analysis, and meta-regression of the association of serial leukocyte counts in critically ill patients and mortality. Ann Intensive Care. Published 19 March 2026. doi:10.
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