Hubungan Antara Neutrofil Limfosit Rasio dan Platelet Limfosit Rasio dengan Mortalitas 90 Hari Pasien Leukemia Akut

Abstract

Background: Acute leukemia is an aggressive hematological malignancy with a still high mortality burden, while local epidemiological data for Indonesia are still limited. Inexpensive and readily available CBC parameters, particularly NLR and PLR, have the potential to be inflammatory-prognostic biomarkers, but evidence of their association with short-term mortality in patients with acute leukemia—especially in the local population—still needs to be strengthened. Objective: To determine the relationship between the Neutrophil Lymphocyte Ratio and the Platelet Lymphocyte Ratio with 90-day mortality in acute leukemia patients at Adam Malik Hospital in Medan Methods: This research is an observational study with a retrospective cohort design, conducted at Adam Malik Hospital in Medan, using secondary data from the medical records of acute leukemia (AML/ALL) patients admitted between January 2022 and June 2024. Data collection was conducted following approval from the ethics committee in October-November 2025. The sampling method applied was total sampling, with inclusion criteria for patients aged ≥18 years who were diagnosed with acute leukemia and had complete laboratory data for calculating the Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR). Excluded patients were those with incomplete data, who received anticoagulants/cryoprecipitate/FFP before sampling, or who were diagnosed with an infection at initial admission. The collected variables include clinical characteristics, complete blood count parameters, induction therapy status, and 90-day mortality outcomes. Results: A total of 73 acute leukemia patients were analyzed (age 38±14.2 years; AML 54.8%; male 49.3%). Mortality within 90 days was 74.0% (54/73), primarily due to embolism/hemorrhage (46.3%) and sepsis (31.5%). Median laboratory values upon admission: Hb 7.5 g/dL, leukocytes 20.21×10³/µL, platelets 35×10⁹/L, NLR 0.63, and PLR 7.81. In the Mann–Whitney test, the NLR did not differ between the deceased and living groups (p=0.965), whereas the PLR was significantly different (p=0.003) and lower in deceased patients. In multivariate analysis, LnPLR was associated with 90-day mortality (OR 0.717; 95%CI 0.515–0.998; p=0.049), whereas LnNLR was not (p=0.597). Conclusion: Studies show that the platelet-lymphocyte ratio (PLR) is significantly associated with 90-day mortality, with patients who died having a lower PLR. Meanwhile, the neutrophil-lymphocyte ratio (NLR) did not show a significant association. PLR upon admission can be used as a triage tool to identify patients at high risk of death. Further research with better control of confounding factors and analysis of dynamic changes in PLR/NLR and leukemia subtypes is needed to validate these results.