Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio.
Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio.
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DOI：
10.1371/journal.pone.0173947
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Aspa J
中科院分区：
文献类型：
--
作者：
Curbelo J;Luquero Bueno S;Galván-Román JM;Ortega-Gómez M;Rajas O;Fernández-Jiménez G;Vega-Piris L;Rodríguez-Salvanes F;Arnalich B;Díaz A;Costa R;de la Fuente H;Lancho Á;Suárez C;Ancochea J;Aspa J
社区获得性肺炎（CAP）患者炎症的增加和持续可导致更高的死亡率。能够测量这种炎症反应不足的生物标志物可能与不良结局相关。我们研究了几种炎症标志物的浓度与CAP患者死亡率之间的关系。这是一项在西班牙大学医院住院的CAP患者的前瞻性研究。在入院时和早期进展（72-120小时）进行血液检查，其中测量C-反应蛋白、降钙素原、肾上腺髓质素原、和肽素、白色血细胞、淋巴细胞计数百分比（LCP）、神经细胞计数百分比（NCP）和神经细胞/淋巴细胞比率（NLR）。结果变量为30天和90天时的死亡率。统计学分析采用Logistic回归、ROC曲线分析和曲线下面积检验。纳入了154例住院CAP患者。随访期间死亡的患者降钙素原、和肽素、肾上腺髓质素原水平较高，LCP水平较低，NCP和NLR水平较高。值得注意的是，多变量分析显示NCP与死亡率之间存在相关性，而与年龄、CAP严重程度和合并症无关。AUC分析表明，NLR和NCP在导纳和早期演变过程中取得了良好的诊断能力。NCP和NLR的ROC检验与分析的新血清生物标志物的ROC检验相似。NLR和NCP是住院CAP患者死亡率的有希望的候选预测因子，两者都更便宜，更容易执行，并且至少与新的血清生物标志物一样可靠。新生物标志物的未来应用不仅需要与经典炎症参数（如白色血细胞计数）进行比较，还需要与NLR和NCP进行比较。
The increase and persistence of inflammation in community-acquired pneumonia (CAP) patients can lead to higher mortality. Biomarkers capable of measuring this inadequate inflammatory response are likely candidates to be related with a bad outcome. We investigated the association between concentrations of several inflammatory markers and mortality of CAP patients. This was a prospective study of hospitalised CAP patients in a Spanish university hospital. Blood tests upon admittance and in the early-stage evolution (72–120 hours) were carried out, where C-reactive protein, procalcitonin, proadrenomedullin, copeptin, white blood cell, Lymphocyte Count Percentage (LCP), Neutrophil Count Percentage (NCP) and Neutrophil/Lymphocyte Ratio (NLR) were measured. The outcome variable was mortality at 30 and 90 days. Statistical analysis included logistic regression, ROC analysis and area-under-curve test. 154 hospitalised CAP patients were included. Patients who died during follow-up had higher levels of procalcitonin, copeptin, proadrenomedullin, lower levels of LCP, and higher of NCP and NLR. Remarkably, multivariate analysis showed a relationship between NCP and mortality, regardless of age, severity of CAP and comorbidities. AUC analysis showed that NLR and NCP at admittance and during early-stage evolution achieved a good diagnostic power. ROC test for NCP and NLR were similar to those of the novel serum biomarkers analysed. NLR and NCP, are promising candidate predictors of mortality for hospitalised CAP patients, and both are cheaper, easier to perform, and at least as reliable as the new serum biomarkers. Future implementation of new biomarkers would require comparison not only with classic inflammatory parameters like White Blood Cell count but also with NLR and NCP.