Sepsis is an unfettered inflammatory response to infection and demonstrates as a variety of illness that ranges clinically from bacteremia to severe sepsis to septic shock [1]. The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction resulting from dysregulated host responses to infection and defined septic shock as a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are profound enough to substantially increase the risk of mortality [1] Sepsis is a public health issue globally and is associated with high mortality. Most data describing the incidence of sepsis are from high-income countries, where 2.8 million deaths per year are attributable to sepsis [2]. Angus et al. reported the incidence of severe sepsis in USA to be more than 300 cases per 100000 populations [3]. The reported prevalence of sepsis in UK is 27% of all ICU admissions, whereas the prevalence is 12% in the USA [4]. In low income countries the morality ranges from 60-80% [5] which is very high and in Pakistan it was documented to be 37% in a tertiary care hospital [5]. In clinical setting various bio markers and scoring systems can be used to diagnose sepsis and forecast it mortality [6], However these markers are either very expensive or not readily available so there is a lot of emphasis on tools that are cost effective, readily available and not only helpful in early diagnosis but can also predict the mortality. Understanding that sepsis is a medical emergency so efforts are made to intervene at the earliest and markers which can guide this immediate response has been studied. Neutrophils to Lymphocytes Ratio (NLR) is well known among the most readily available marker of sepsis diagnosis and prognostication [6], however its role in the prognosis is not studied in local population. Our objective in this retrospective study is to determine the association between NLR and hospital mortality rate among patients with sepsis.

Materials and Methods A retrospective observational study conducted from 30th November 2020 to 31st March 2021 in tertiary care hospital of Karachi, Pakistan. Data was collected from patient’s medical record after obtaining permission from institute ethical review committee (ERC# 2020-5643-14944). We included all adult patients of age above 18 years of either gender, admitted in Medicine department of Aga khan university hospital with diagnosis of sepsis on arrival or during hospital stay. Patients were diagnosed as septic based on the SOFA score. We excluded patients with massive blood loss and having severe disease complication such as myocardial infraction, pulmonary embolism, rheumatoid arthritis. No patient identifiers were recorded to protect patient’s privacy. A trained research staff collected the data based on the inclusion criteria which included all data on patient’s demographic, data of inflammatory markers along with important vital and physical signs. A total of 168 patients has been selected using 10% level of significance, 90% confidence interval and 5% margin of error with 50% anticipated proportion of Sepsis. Patients were included within the period of 3 months. Data was entered and analysed in SPSS version 25. Descriptive analysis was performed on all the variables. Categorical variables were presented in form of frequency and percentages whereas quantitative variables were presented in form of mean (SD) or Median (IQR) depending upon the distribution of the Variable. Data was stratified according to age and gender. An appropriate statistical test was applied post stratification. P-value equal or less than 0.05 was considered significant.