Neutrophil lymphocyte ratio NLR is an important index that evaluate the inflammatory status . It is a cost effective and readily available , and simply calculated , so that why investigators try to use it as a predictor of short term survival in the critically ill patients

NLR will be used as predictor for short term survival and patients stay in ICU in 2 groups of patients . Investigators will use it in a group of Medical Critically ill patients as respiratory failure , neuromuscular disorders , renal impairment . the other group is the critically ill surgical patients , as patients with multiple trauma , post major surgery

Inclusion Criteria:

• Critically ill trauma patients

Exclusion Criteria:

• auto immune disease endocrine disease renal dysfunction hepatic dysfunction malignancy smoking

80 adult patients who are admitted to critical care unit in Assiut university Hospital