Neutrophil-to-Lymphocyte Ratio in Adult Community-Acquired Pneumonia Patients Correlates with Unfavorable Clinical Outcomes
Neutrophil-to-Lymphocyte Ratio in Adult Community-Acquired Pneumonia Patients Correlates with Unfavorable Clinical Outcomes
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DOI：
10.7754/clin.lab.2018.181042
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发表时间：
2019-01-01
影响因子：
0.7
通讯作者：
Wang, Hong Y.
中科院分区：
文献类型：
--
作者：
Ge, Yan L.;Zhang, Hai F.;Wang, Hong Y.
背景资料：尽管抗生素治疗和医疗保健得到了广泛的改善，但严重的成人社区获得性肺炎（CAP）仍然是全球死亡的重要原因。对成人CAP患者进行早期预后评估和及时治疗有助于预后。血常规中的嗜中性粒细胞/淋巴细胞比值（NLR）在评估炎症反应和预后方面具有广泛的应用前景。本研究的目的是研究NLR和炎症反应之间的关系，并解开NLR在成人CAP patients.Methods的临床结局评估的有用性：这项回顾性研究进行了初步诊断CAP的成人患者的基础上。所有患者均接受常规血液检查和计算NLR。计量资料采用配对t检验，计数资料采用卡方检验。进行多变量分析以研究预测因素（年龄、男性、CURB-65评分、合并症、NLR和其他血常规中的炎性细胞）与CAP不利结局（ICU入院和30天死亡率）之间的相关性。应用受试者工作特征曲线（ROC）评价NLR预测CAP不良预后的敏感性和特异性。与预后良好组相比，预后不良组患者的年龄、CURB-65评分、WBC、中性粒细胞和淋巴细胞计数、NLR均显著升高（p < 0.05），性别、合并症差异无统计学意义。多因素Logistic回归分析显示CURB-65评分和NLR是不良预后的独立预测因素（p < 0.05）。NLR的ROC曲线下面积（AUC）为0.81（95% CI 0.73 ~ 0.89），敏感性为81.00%，特异性为72.8%。NLR在预测不良结局方面上级于CURB-65。NLR联合CURB-65的敏感性和特异性分别为89.40%和91.30%。
Background: Despite the extensive improvement in antibiotic treatment and medical care, severe adult community-acquired pneumonia (CAP) remains as the significant cause of death worldwide. Earlier prognosis assessment and timely treatment in adult CAP patients are useful for prognosis. The neutrophil-to-lymphocyte ratio (NLR) in blood routine has a broad application possibility in assessing inflammatory reaction and prognosis. The aim of this study was to examine the relationship between NLR and inflammatory reaction and to unravel the usefulness of NLR in the assessment of clinical outcomes in adult CAP patients.Methods: This retrospective study was conducted based on adult patients with a primary diagnosis of CAP. All patients included received a routine blood test and calculated NLR. All of the measurement data were analyzed with paired t-test and the enumeration data were analyzed with chi(2) test. Multivariate analysis was performed to investigate the association between predictors (age, male, CURB-65 scores, comorbidity, NLR, and other inflammatory cells in blood routine) and unfavorable outcomes of CAP (ICU admission and 30-day mortality). Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of NLR in predicting unfavorable outcomes of CAP.Results: One hundred fifty patients were included. Compared with favorable outcomes group, age, CURB-65 scores, WBC, neutrophil and lymphocyte counts, and NLR were elevated in unfavorable outcomes group (p < 0.05), gender and coexisting illness did not differ obviously. Multivariate logistic regression model analysis showed CURB-65 scores and NLR were independent predictors correlated with unfavorable outcomes (p < 0.05). The area under the ROC curve (AUC) of NLR was 0.81 (95% CI 0.73 to 0.89), the sensitivity was 81.00% and specificity was 72.8%. NLR is superior to CURB-65 in predicting unfavorable outcomes. NLR combined CURB-65 has better sensitivity and specificity (89.40% versus 91.30%).Conclusions: NLR is a simple, cheap, and rapidly available measurement in blood routine and is associated with unfavorable clinical outcomes in adult CAP patients.