scholarly journals Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250067
Author(s):  
Heock Lee ◽  
Insu Kim ◽  
Bo Hyoung Kang ◽  
Soo-Jung Um
Keyword(s):  
Treatment Response ◽  
Early Treatment ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Icu Admission ◽  
Incremental Change ◽  
Early Treatment Response

Introduction Several serum inflammatory markers are associated with poor clinical outcomes in community-acquired pneumonia (CAP). However, the prognosis and early treatment response in hospitalized CAP patients based on serial neutrophil-to-lymphocyte ratio (NLR) measurement has never been investigated. Methods We performed a retrospective observational study for 175 consecutive patients hospitalized with CAP between February 2016 and February 2018. NLR, C-reactive protein (CRP) and procalcitonin levels were measured on admission day (D1) and on hospital day 4 (D4). The Pneumonia Severity Index (PSI) was also assessed on admission. The primary endpoint was all-cause death within 30 days after admission. The secondary endpoint was early treatment response such as intensive care unit (ICU) admission during hospitalization and clinical unstability on day 4. Results The 30-day mortality rate was 9.7%. In multivariate analysis, NLR D4 (OR: 1.11; 95% CI: 1.04–1.18; P = 0.003) and its incremental change (NLR D4/D1 >1) (OR: 7.10; 95% CI: 2.19–23.06; P = 0.001) were significant predictors of 30-day mortality. NLR D4 and its incremental change were significant predictors of ICU admission and clinical unstability on day 4 in multivariate analyses. Adding of incremental NLR change significantly improved the prognostic ability of the PSI. The additive value of incremental NLR change for the prognostic ability of the PSI was larger than that of incremental CRP change. Conclusion Serial NLR measurement represents useful laboratory tool to predict the prognosis and early treatment response of hospitalized CAP patients.

scholarly journals Neutrophil-to-Lymphocyte Ratio Predicts Mortality in Adult Renal Transplant Recipients with Severe Community-Acquired Pneumonia

Pathogens ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 913
Author(s):  
Yue Qiu ◽  
Ying Su ◽  
Guo-Wei Tu ◽  
Min-Jie Ju ◽  
Hong-Yu He ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Pneumonia Severity Index ◽  
Area Under The Curve ◽  
Community Acquired Pneumonia ◽  
Neutrophil To Lymphocyte Ratio ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Lymphocyte Ratio ◽  
Laboratory Test Results ◽  
Severe Community Acquired Pneumonia

Mortality of renal transplant recipients with severe community-acquired pneumonia (CAP) remains high, despite advances in critical care management. There is still a lack of biomarkers for predicting prognosis of these patients. The present study aimed to investigate the association between neutrophil-to-lymphocyte ratio (NLR) and mortality in renal transplant recipients with severe CAP. A total of 111 renal transplant recipients with severe CAP admitted to the intensive care unit (ICU) were screened for eligibility between 1 January 2009 and 30 November 2018. Patient characteristics and laboratory test results at ICU admission were retrospectively collected. There were 18 non-survivors (22.2%) among 81 patients with severe CAP who were finally included. Non-survivors had a higher NLR level than survivors (26.8 vs. 12.3, p < 0.001). NLR had the greatest power to predict mortality as suggested by area under the curve (0.88 ± 0.04; p < 0.0001) compared to platelet-to-lymphocyte ratio (0.75 ± 0.06; p < 0.01), pneumonia severity index (0.65 ± 0.08; p = 0.05), CURB-65 (0.65 ± 0.08; p = 0.05), and neutrophil count (0.68 ± 0.07; p < 0.01). Multivariate logistic regression models revealed that NLR was associated with hospital and ICU mortality in renal transplant recipients with severe CAP. NLR levels were independently associated with mortality and may be a useful biomarker for predicting poor outcome in renal transplant recipients with severe CAP.

scholarly journals Predicting value of neutrophil–lymphocyte ratio and CURB-65 score for early clinical stability of adult community-acquired pneumonia

2019 ◽  
Vol 17 ◽  
pp. 205873921983510
Author(s):  
Xuegui Ju ◽  
Shaoqiang Tao ◽  
Hui Zhou ◽  
Qianglin Zeng
Keyword(s):  
Pneumonia Severity Index ◽  
Area Under The Curve ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Clinical Instability ◽  
Combined Test ◽  
Clinical Stability

Early clinical stability has been proven to be vital for the treatment of community-acquired pneumonia (CAP). This research retrospectively analyzed the predictive implication of neutrophil–lymphocyte ratio (NLR) and confusion, urea >7 mmol/L, respiratory rate ⩾30 breaths/min, low blood pressure, and age ⩾65 years (CURB-65) score to predict early clinical stability of the adult CAP. Clinical data, CURB-65 scores, pneumonia severity index (PSI) scores, NLR on admission (within 24 h) of 230 patients between January 2012 and June 2015 were obtained from the Affiliated Hospital of Chengdu University. Instable patients had significantly higher CURB-65, PSI, white blood cell (WBC), neutrophil, and NLR than the stable patients ( P < 0.05); NLR was positively correlated with CURB-65 (r = 0.270, P < 0.001) and PSI (r = 0.316, P < 0.001). NLR and CURB-65 were screened as risk factors through the discriminant analysis. The area under the curve (AUC) was 0.662 (95% confidence interval (CI): (0.569, 0.756), P = 0.002) for NLR, 0.670 (95% CI (0.569, 0.772) P = 0.001) for CURB-65. The enhanced predictive power was observed for combining NLR-CURB-65 with the AUC of 0.704 (95% CI (0.606, 0.802), P < 0.001). The risk of early clinical instability rose significantly in patients with NLR (odds ratio (OR) = 3.440, 95% CI (1.741, 6.798) with the cut-off value of NLR = 6.161) and higher CURB-65 (OR = 3.797, 95% CI (1.801, 8.005), with the CURB-65 cut-off value of 1.5). Both NLR and CURB-65 are qualitatively accurate for predicting early clinical stability of CAP, an accuracy-enhanced predicting power was observed in the NLR-CURB-65 combined test, further large-sample studies are required to validate the conclusion.

scholarly journals Prognostic Value of Immune-Inflammatory Index in PSI IV-V Patients with COVID-19

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Rui Han ◽  
Honghui Su ◽  
Gangwen Guo ◽  
Qiao Wang ◽  
Jiahui Ma ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Neutrophil To Lymphocyte Ratio ◽  
Pneumonia Severity ◽  
Lymphocyte Ratio ◽  
Inflammatory Index ◽  
Risk Of Mortality ◽  
The Relationship ◽  
Initial Research

Objective. Respiratory failure is the leading cause of mortality in COVID-19 patients, characterized by a generalized disbalance of inflammation. The aim of this study was to investigate the relationship between immune-inflammatory index and mortality in PSI IV-V patients with COVID-19. Methods. We retrospectively reviewed the medical records of COVID-19 patients from Feb. to Apr. 2020 in the Zhongfa Xincheng Branch of Tongji Hospital, Wuhan, China. Patients who presented high severity of COVID-19-related pneumonia were enrolled for further analysis according to the Pneumonia Severity Index (PSI) tool. Results. A total of 101 patients diagnosed with COVID-19 were identified at initial research. The survival analysis revealed that mortality of the PSI IV-V cohort was significantly higher than the PSI I-III group ( p = 0.0003 ). The overall mortality in PSI IV-V patients was 32.1% (9/28). The fatal cases of the PSI IV-V group had a higher level of procalcitonin ( p = 0.022 ) and neutrophil-to-lymphocyte ratio ( p = 0.033 ) compared with the survivors. Procalcitonin was the most sensitive predictor of mortality for the severe COVID-19 population with area under receiver operating characteristic curve of 0.78, higher than the neutrophil-to-lymphocyte ratio (0.75) and total lymphocyte (0.68) and neutrophil (0.67) counts. Conclusion. Procalcitonin and neutrophil-to-lymphocyte ratio may potentially be effective predictors for mortality in PSI IV-V patients with COVID-19. Increased procalcitonin and neutrophil-to-lymphocyte ratio were associated with greater risk of mortality.

scholarly journals Comparative study of CURB-65, Pneumonia Severity Index and IDSA/ATS scoring systems in community acquired pneumonia in an Indian tertiary care setting

2017 ◽  
Vol 4 (3) ◽  
pp. 693 ◽  
Author(s):  
S. Madhu ◽  
Sabu Augustine ◽  
Y. S. Ravi Kumar ◽  
Kauser Kauser M. M. ◽  
S. R. Vagesh Kumar ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Tertiary Care ◽  
Pneumonia Severity Index ◽  
Scoring Systems ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Class Iii ◽  
Pneumonia Severity ◽  
Icu Admission ◽  
Class Iv

Background: Few comparative studies regarding prognostic scoring systems for community acquired pneumonia (CAP) are available from Indian context.Methods: Hospital-based prospective study to test the comparison between confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65), Pneumonia severity index (PSI) and infectious diseases society of America/American thoracic society criteria (IDSA/ATS) scoring systems in patients with community acquired pneumonia.Results: CURB-65 class ≥III, PSI class ≥IV and patients who needed admission to intensive care unit (ICU) based on IDSA/ATS criteria were having sensitivity of 41.7%, 91.7% and 87.5% in predicting ICU admission with a specificity of 89.5%, 59.2% and 73.7% respectively. Their sensitivity in predicting death were 44.4%, 88.9% and 83.3% with a specificity of 87.8%, 54.9% and 68.3% respectively. In both PSI score and IDSA/ATS criteria risk scoring systems, mortality rate, need for ICU admission increased progressively with increasing scores but CURB-65 score did not show this correlation. The PSI class ≥IV was more sensitive in predicting ICU admission than CURB-65 and IDSA/ATS criteria.Conclusions: PSI was most sensitive in both predicting ICU admission and death whereas CURB-65 is most specific in predicting ICU admission and death. But CURB-65 is least sensitive in both predicting ICU admission and death. Even though IDSA/ATS criteria did not have highest sensitivity and specificity as single criteria it had modest sensitivity and specificity in predicting ICU admission and death.

scholarly journals Early Treatment Outcomes for Bloodstream Infections Caused by Potential AmpC Beta-lactamase-producing Enterobacterales with Focus on Piperacillin/Tazobactam: A Retrospective Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 665
Author(s):  
Lena Herrmann ◽  
Aurelia Kimmig ◽  
Jürgen Rödel ◽  
Stefan Hagel ◽  
Norman Rose ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Outcomes ◽  
Treatment Response ◽  
Sofa Score ◽  
Early Treatment ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Beta Lactamase ◽  
Early Treatment Response

The Gram-negative bacilli Serratia spp., Providencia spp., Morganella morganii, Citrobacter freundii complex, Enterobacter spp. and Klebsiella aerogenes are common Enterobacterales that may harbor inducible chromosomal AmpC beta-lactamase genes. The purpose of the present study was to evaluate treatment outcomes and identify predictors of early treatment response in patients with bloodstream infection caused by potential AmpC beta-lactamase-producing Enterobacterales (SPICE-BSI). This cohort study included adult patients with SPICE-BSI hospitalized between 01/2011 and 02/2019. The primary outcome was early treatment response 72 h after the start of active treatment, defined as survival, hemodynamic stability, improved or stable SOFA score, resolution of fever and leukocytosis and microbiologic resolution. Among 295 included patients, the most common focus was the lower respiratory tract (27.8%), and Enterobacter spp. (n = 155) was the main pathogen. The early treatment response rate was significantly lower (p = 0.006) in the piperacillin/tazobactam group (17/81 patients, 21.0%) than in the carbapenem group (40/82 patients, 48.8%). Independent negative predictors of early treatment response (p < 0.02) included initial SOFA score, liver comorbidity and empiric piperacillin/tazobactam treatment. In vitro piperacillin/tazobactam resistance was detected in three patients with relapsed Enterobacter-BSI and initial treatment with piperacillin/tazobactam. In conclusion, our findings show that piperacillin/tazobactam might be associated with early treatment failure in patients with SPICE-BSI.

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