Introduction

Sepsis is a serious medical condition caused by an abnormal and uncontrolled response of the body to infection [1]. It can rapidly progress to organ dysfunction, septic shock, and death if not recognized early. According to the Sepsis-3 definition, sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection [2]. Early recognition of organ dysfunction remains one of the most important steps in the management of septic patients.

Sepsis remains a major public health challenge in low- and middle-income countries, including those in South Asia, where delayed diagnosis, limited healthcare resources, and high infection rates contribute to poor clinical outcomes. In Pakistan, early recognition of sepsis is often challenging because access to advanced diagnostic tools, including biomarkers such as procalcitonin and IL-6, and timely microbiological investigations may be limited, particularly in resource-constrained hospitals. Consequently, readily available laboratory markers are of considerable clinical value for early risk assessment [3]. Therefore, there is a need for simple, inexpensive, and readily available biomarkers that can help identify patients at risk of organ dysfunction during the early stages of sepsis.

Inflammation plays a central role in the development of sepsis-related organ injury. During infection, neutrophils increase as part of the body’s first immune response, while lymphocyte counts often decrease because of immune dysregulation and cellular apoptosis [4]. The neutrophil-to-lymphocyte ratio (NLR) combines these two changes into a single marker. Because it can be calculated from a routine CBC, NLR has gained attention as a practical indicator of systemic inflammation [5]. Recent systematic reviews and meta-analyses have reported that elevated NLR is associated with greater disease severity, poor prognosis, and increased mortality among septic patients [6,7].

Kidney dysfunction is one of the most common complications of sepsis. Reduced tissue perfusion, inflammatory injury, and microvascular disturbances may impair renal function during the early phase of the disease [8]. Serum creatinine is an inexpensive and routinely performed laboratory test that is available in most secondary and tertiary healthcare facilities and in many primary healthcare settings. Its widespread use makes it a practical marker for assessing kidney dysfunction in patients with suspected sepsis, particularly where access to advanced biomarkers is limited [9]. An increase in serum creatinine may indicate early organ dysfunction and help clinicians identify patients who require closer monitoring and aggressive treatment [10].

Although several international studies have evaluated NLR and serum creatinine individually, evidence regarding their combined role in predicting sepsis-related organ dysfunction remains limited in Pakistan. This study was therefore conducted to address this important local evidence gap. However, as the findings are derived from a single-center population, further multicenter studies are needed to confirm their generalizability across different healthcare settings and populations. The present study was conducted to assess the predictive role of NLR and serum creatinine in the early detection of sepsis-related organ dysfunction among patients presenting to a tertiary care hospital in Pakistan.