2018, Number 6
<< Back Next >>
Rev Med Inst Mex Seguro Soc 2018; 56 (6)
Neutrophil-to-lymphocyte ratio as a serum biomarker associated with community acquired pneumonia
Che-Morales JL, Cortes-Telles A
Language: Spanish
References: 21
Page: 537-543
PDF size: 982.86 Kb.
ABSTRACT
Background: Community acquired pneumonia (CAP) is
the main infectious cause of mortality in the world.
Several scales evaluates outcomes, however the current
tendency favors using biomarkers as surrogates of
clinical prognosis.
Objective: To evaluate utility of neutrophil-tolymphocyte
ratio to identify severe patients according to
Pneumonia Severity Index scale.
Methods: Observational and retrospective study in
adults ≥18 years old with CAP, evaluated in an
emergency ward of a secondary level hospital.
Demography, laboratory results, treatment and
Pneumonia Severity Index scale (PSI) data were
collected. The neutrophil-to-lymphocyte ratio (NLR)
between two groups was compared, high risk vs. low risk
of complications according to PSI.
Results: We studied 94 patients. There were not
differences in tobacco smoking, comorbidities and
outcomes between groups. Neutrophil total count,
lymphopenia, and NLR were more elevated in the high risk
group (p ‹ 0.05). Uni and multivariate analysis showed that
neutrophils and NLR could be surrogate of PSI III or higher
(OR: 1.05 and 1.14 respectively). A NLR value ≥ 7.2
provided that probability (AUC 0.65; IC 95% 0.53-0.78).
Conclusion: NLR is useful to identify patients with grave
pneumonia and risk of complications according to PSI.
REFERENCES
World Health Organization. The top 10 causes of death. Updated 24 May 2018. [Consultado el 25 de julio de 2018] Disponible en: https://www.who.int/news-room/factsheets/ detail/the-top-10-causes-of-death
Escobar-Rojas A, Castillo-Pedroza J, Cruz-Hervert P, Báez-Saldaña R. Tendencias de morbilidad y mortalidad por neumonía en adultos mexicanos (1984-2010). Neumol Cir Torax. 2015; 74(1):4-12.
Gatarello S, Ramírez S, Almarales JR, Borgatta B, Lagunes L, Encina B, et al. Causes of non-adherence to therapeutic guidelines in severe community acquired pneumonia. Rev Bras Ter Intensiva. 2015; 27(1):44-50.
Waterer G. Severity Scores and Community-acquired Pneumonia: Time to Move Forward. Am J Respir Crit Care Med. 2017; 196(10):1236-8.
Cataudella E, Giraffa CM, Di Marca S, Pulvirenti A, Alaimo S, Pisano M, et al. Neutrophil-To-Lymphocyte Ratio: An Emerging Marker Predicting Prognosis in Elderly Adults with Community-Acquired Pneumonia. J Am Geriatr Soc. 2017; 65(8):1796-801.
Salciccioli JD, Marshall DC, Pimentel MA, Santos MD, Pollard T, Celi LA, et al. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care. 2015; 19(1):13.
Loonen AJ, de Jager CP, Tosserams J, Kusters R, Hilbink M, Weber PC, et al. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS ONE. 2014; 9(1): e87315. doi:10.1371/journal.pone.0087315.
Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009; 64(Supl. III):iii1-iii55.
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(4): 243-50.
Williams JR. The Declaration of Helsinki and public health. Bull World Health Organ. 2008; 86(8): 650-2.
Riché F, Gayat E, Barthélémy R, Le Dorze M, Matéo J, Payen D. Reversal of neutrophil-to-lymphocyte count 2 ratio in early versus late death from septic shock. Crit Care. 2015; 19:439.
Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102(1):5-14.
Unsinger J, Kazama H, McDonough JS, Hotchkiss RS, Ferguson TA. Differential lymphopenia-induced homeostatic proliferation for CD4+ and CD8+ T cells following septic injury. J Leukoc Biol. 2009 Mar; 85(3): 382-90.
Shankar-Hari M, Fear D, Lavender P, Mare T, Beale R, Swanson C, et al. Activation-Associated Accelerated Apoptosis of Memory B Cells in Critically Ill Patients With Sepsis. Crit Care Med. 2017; 45(5):875-82.
de Jager CP, Wever PC, Gemen EF, Kusters R, van Gageldonk-Lafeber Ab, Van der Poll T , et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS ONE. 2012; 7(10): e46561. doi:10.1371/journal.pone.0046561.
Báez-Saldaña R, Gómez-Zamora C, López-Elizondo C, Molina-Corona H, Santillán-Martínez A, Sánchez- Hernández J, et al. Neumonía adquirida en la comunidad. Revisión y actualización con una perspectiva orientada a la calidad de la atención médica. Neumol Cir Torax. 2013; 72 (Supl. 1): 6-43.
Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic Significance of Neutrophil-to-lymphocyte Ratio in Patients with Sepsis: A Prospective Observational Study. Mediators of inflammation. 2016; DOI:10.1155/2016/8191254
Lee JH, Song S, Soo Y, Yoon SY, Lim CS, Song JW et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as diagnostic markers for pneumonia severity. Br J Biomed Sci. 2016; 73(3):140-2. DOI: 10.1080/09674845.2016.1209898.
Curbelo J, Luquero-Bueno S, Galván-Román JM, Ortega- Gómez M, Rajas O, Fernández-Jiménez E, et al. Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio. PLoS ONE. 2017; 12(3): e0173947. https://doi.org/10.1371/journal. pone.0173947.
Farah R, Bleier J, Gilbey P, Khamisy-Farah R. Common Laboratory Parameters for Differentiating Between Community-Acquired and Healthcare-Associated Pneumonia. J Clin Lab Anal. 2017; 31(1):e22016.
Li X, Zhu M, Wang J. Clinical application of neutrophil/lymphocyte count ratio in the diagnosis of lung bacterial infections in the elderly. Zhonghua Yi Xue Za Zhi. 2015; 95(18):1405-10.