Can neutrophil-to-lymphocyte ratio and proatherogenic risk factors improve the accuracy of pneumonia severity index in the prediction of community acquired pneumonia outcome in healthy individuals?
Department of Pharmacology, Toxicology and Clinical Pharmacology, School of Medicine, Sarajevo School of Science and Technology,
Sarajevo, Bosnia and Herzegovina
Aim To investigate influence of neutrophil-to-lymphocyte ratio (NLR) and proatherogenic risk factors to improve the accuracy of pneumonia severity index (PSI) in the prediction of community acquired pneumonia (CAP) outcome in healthy individuals. Methods A retrospective observational cross-sectional study conducted at the Clinic for Pulmonary Diseases and Tuberculosis “Podhrastovi”, University Clinical Centre Sarajevo, included 83 patients with the diagnosis of CAP during the period March 2019-March 2021. Once diagnosed with CAP, PSI score was calculated and according to its value the need for hospital treatment was identified. Patients were divided in two groups: low risk of CAP (PSI <90), and high risk of CAP (PSI> 90). Results The overall average hospital stay was 22.76±10.154 days. In the patients diagnosed with CAP, a positive correlation was established between the following parameters PSI score and age (r=0.670; p<0.01), C-reactive protein-CRP (rho=0.287; p<0.01), leukocytes (rho=0.406; p<0.01), NLR (rho=0.313; p<0.01) and platelet to lymphocyte ratio (PLR) (0.296; p<0.05). CRP, leukocytes, NLR and PLR were statistically significantly higher in patients with high risk of CAP compared to patients with low risk of CAP. Diastolic blood pressure, lymphocytes, eosinophils were significantly lower in patients with high risk of CAP (p<0.05;) compared to patients with low risk of CAP (p<0.01). The optimal cut-off value of NLR for CAP patients was 3.089 with an estimated area under curve (AUC) of 0.664. Conclusion Proatherogenic parameters such as age, systolic blood pressure and leukocytes in combination with neutrophil-lymphocyte count ratio could improve accuracy of the pneumonia severity index in community acquired pneumonia outcome.
Christ-Crain M, Müller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J. 2007. p. 556–73.
2.
Schuetz P, Christ-Crain M, Müller B. Biomarkers to improve diagnostic and prognostic accuracy in systemic infections. Curr Opin Crit Care. 2007. p. 578–85.
3.
Violi F, Cangemi R, Falcone M, Taliani G, Pieralli F, Vannucchi V, et al. SIXTUS (Thrombosis-Related Extrapulmonary Outcomes in Pneumonia) Study Group. Cardiovascular complications and short-term mortality risk in community-acquired pneumonia. Clin Infect Dis. 2017. p. 1486–93.
4.
Vf CM, Alvarez K, Weissfeld L, Angus D, Chirinos J, Chang C, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015. p. 264–74.
5.
Reyes L, Restrepo M, Hinojosa C, Soni N, Anzueto A, Babu B, et al. Severe pneumococcal pneumonia causes acute cardiac toxicity and subsequent cardiac remodeling. Am J Respir Crit Care Med. 2017. p. 609–20.
6.
Begic E, Obradovic S, Jankovic S, Romanovic R, Djenic N, Dzudovic B, et al. Increased C-reactive protein is associated with major adverse cardiovascular events after STEMI. Erciyes Med J. 2020. p. 276–80.
7.
Waterer G. Severity Scores and community-acquired pneumonia. Time to move forward. Am J Respir Crit Care Med. 2017. p. 1236–8.
8.
Kim M, Park J, Lee C, Choi W. Pneumonia severity index in viral community acquired pneumonia in adults. PLoS One. 2019. p. 210102.
9.
Karakioulaki M, Stolz D. Biomarkers in pneumoniabeyond procalcitonin. Int J Mol Sci. 2019.
10.
Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001. p. 5–14.
11.
Henry B, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a metaanalysis. Acta Biomed. 2020.
12.
Ye W, Chen X, Huang Y, Li Y, Xu Y, Liang Z, et al. The association between neutrophilto-lymphocyte count ratio and mortality in septic patients: a retrospective analysis of the MIMIC-III database. J Thorac Dis. 2020. p. 1843–55.
13.
Singanayagam A, Singanayagam A, Elder D, Chalmers J. Is community-acquired pneumonia an independent risk factor for cardiovascular disease? Eur Respir J. 2012. p. 187–96.
14.
Feldman C, Anderson R. Platelets and their role in the pathogenesis of cardiovascular events in patients with community-acquired pneumonia. Front Immunol. 2020. p. 577303.
15.
Menéndez R, Martínez R, Reyes S, Mensa J, Filella X, Marcos M, et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax. 2009. p. 587–91.
16.
Hohenthal U, Hurme S, Helenius H, Heiro M, Meurman O, Nikoskelainen J, et al. Utility of Creactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect. 2009. p. 1026–32.
17.
Chalmers J, Singanayagam A, Hill A. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med. 2008. p. 219–25.
18.
Menéndez R, Cavalcanti M, Reyes S, Mensa J, Martinez R, Marcos M, et al. Markers of treatment failure in hospitalised community acquired pneumonia. Thorax. 2008. p. 447–52.
19.
Ridker P, Hennekens C, Buring J, Rifai N. Creactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000. p. 836–43.
20.
Menéndez R, Méndez R, Aldás I, Reyes S, Gonzalez-Jimenez P, España P, et al. Community-acquired pneumonia patients at risk for early and long-term cardiovascular events are identified by cardiac biomarkers. Chest. 2019. p. 1080–91.
21.
Cavallazzi R, Ramirez J. Community-acquired pneumonia in chronic obstructive pulmonary disease. Curr Opin Infect Dis. 2020. p. 173–81.
22.
Kolditz M, Ewig S, Hoffken G. Management-based risk prediction in community-acquired pneumonia by scores and biomarkers. Eur Respir J. 2013. p. 974–84.
23.
Modi A, Kovacs C. Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention. Cleve Clin J Med. 2020. p. 633–9.
24.
Şahin F, Aslan F, A, Karaçar K, C. Which is the most effective inflammatory marker in the diagnosis, severity and treatment follow-up of patients with pneumonia? European Respiratory Journal. 2019. p. A4541.
25.
Spoto S, Lupoi D, Valeriani E, Fogolari M, Locorriere L, Anguissola B, et al. Angeletti S. Diagnostic accuracy and prognostic value of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in septic patients outside the intensive care unit. Medicina (Kaunas). p. 811.
26.
Mjid M, Taboubi A, Toujani S, Khaled S, Hedhli S, Cheikhrouhou A, et al. The Neutrophil-lymphocyte ratio in patients with community-acquired pneumonia. European Respiratory Journal. 2018. p. A2620.
27.
Huang Y, Liu A, Liang L, Jiang J, Luo H, Deng W, et al. Diagnostic value of blood parameters for community-acquired pneumonia. Int Immunopharmacol. 2018. p. 10–5.
28.
Cortes-Telles CMJ, A. Neutrophil-tolymphocyte ratio as a serum biomarker associated with community acquired pneumonia. Rev Med Inst Mex Seguro Soc. 2018. p. 537–43.
29.
Mozos I, Malainer C, Horbańczuk J, Gug C, Stoian D, Luca C, et al. Inflammatory markers for arterial stiffness in cardiovascular diseases. Front Immunol. 2017. p. 1058.
30.
Kang Y, Fang X, Wang D, Wang X. Factors associated with acute myocardial infarction in older patients after hospitalization with community-acquired pneumonia: a cross-sectional study. BMC Geriatr. 2021. p. 113.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
