Utilidad Pronóstica del Índice Neutrófilo-Linfocito (NLR) en Pacientes Hospitalizados con Sepsis: Revisión Sistemática y Metaanálisis
Resumen
Introducción: La sepsis constituye una de las principales causas de morbimortalidad hospitalaria a nivel mundial y continúa representando un desafío clínico debido a la dificultad para identificar tempranamente a los pacientes con alto riesgo de deterioro y muerte. En este contexto, el índice neutrófilo-linfocito (NLR) ha emergido como un biomarcador inflamatorio accesible y de bajo costo con potencial utilidad pronóstica en pacientes sépticos. Objetivo: Evaluar la utilidad pronóstica del índice neutrófilo-linfocito en pacientes hospitalizados con sepsis mediante una revisión sistemática y metaanálisis de la literatura disponible. Metodología: Se realizó una revisión sistemática siguiendo las recomendaciones PRISMA 2020. La búsqueda bibliográfica se efectuó en PubMed/MEDLINE, Scopus y Web of Science utilizando términos relacionados con “sepsis”, “neutrophil-to-lymphocyte ratio”, “mortality” y “prognosis”. Se incluyeron estudios observacionales, cohortes y metaanálisis en pacientes adultos con sepsis o choque séptico que evaluarán el valor pronóstico del NLR. Los principales desenlaces analizados fueron mortalidad hospitalaria, gravedad clínica y disfunción orgánica. Resultados: Se incluyeron 20 estudios publicados entre 2016 y 2025, comprendiendo cohortes prospectivas, retrospectivas y metaanálisis [1–20]. La evidencia analizada demostró asociación consistente entre valores elevados de NLR y aumento de mortalidad hospitalaria [1,3,5,11,12]. Diversos estudios reportaron correlación significativa entre NLR elevado y mayor gravedad clínica evaluada mediante escalas como SOFA y APACHE II [14,20]. Asimismo, la evaluación dinámica del NLR mostró relevancia pronóstica adicional, ya que la persistencia de valores elevados durante la hospitalización se asoció con peor evolución clínica y mayor riesgo de muerte [8,13,17]. Algunos estudios demostraron que la combinación del NLR con otros biomarcadores inflamatorios, incluyendo interleucina-6 y relación plaqueta-linfocito, mejora la precisión pronóstica [2,9,10]. Conclusiones: El índice neutrófilo-linfocito representa un biomarcador pronóstico prometedor en pacientes hospitalizados con sepsis, debido a su asociación consistente con mortalidad y gravedad clínica. Su bajo costo y disponibilidad universal favorecen su potencial implementación clínica. Sin embargo, la heterogeneidad metodológica observada entre estudios y la ausencia de puntos de corte estandarizados limitan su incorporación rutinaria en la práctica clínica. Son necesarios estudios prospectivos multicéntricos que permitan validar y estandarizar su utilidad pronóstica.
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Derechos de autor 2026 Mariela Alondra Garrido Cruz , Guillermo Hernández Morales , Jesús Rodolfo Valenzuela Ruiz , Andoni Ramírez Rendón , Hanna Baruch Toledo, Katia Giselle Juárez Camarillo, Pedro Chaidez Vazquez , Katia Bublitz San Roman , Andrea Isaura Tejero Carrillo
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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