scholarly journals Changes of the Blood Lymphocytes On Severe Trauma Patients in Early Time

2021 ◽  
Author(s):  
Feng Cao ◽  
Ru He ◽  
Yan Huang ◽  
Zi Li ◽  
Xiaoheng Wu ◽  
...  
Keyword(s):  
Lymphocyte Count ◽  
Injury Severity ◽  
Tissue Injury ◽  
Area Under The Curve ◽  
Early Time ◽  
Trauma Patients ◽  
Lymphocyte Ratio ◽  
Significant Difference ◽  
Secondary Tissue ◽  
Severe Tissue

Abstract Purpose: To evaluate the relationship between the change of blood lymphocyte counts in early stages of trauma patients and the secondary tissue injury after trauma. Method: A retrospective study was conduct to include trauma patients with Injury Severity Score(ISS) ≥16 between January 1 st , 2018 and December 31 st , 2019. Lymphocyte counts of each trauma patient were collected and recorded in first 3 hours, 6-12 hours, 24-48 hours, and 49-72 hours after trauma, separately. The degree of secondary on the trauma patients were evaluated according to the results of laboratory tests, the time stay in ICU and received mechanical ventilation, and 28-day outcome. Correlation analysis was performed between lymphocytes change and the score of the secondary tissue injury in severe trauma patients. Results: The lymphocyte count within first 3 hours after trauma was significantly high,the median was 4.03×10 9 /L, then dropped significantly in 6-72 hours after trauma (median: 0.85~0.99×10 9 /L), there was a significant statistical difference between the lymphocyte count within first 3 hours after trauma and that in 6-72 hours（P=0.000). The ratios of the lymphocytes counts in 6-72 hours to that within first 3 hours after trauma were very low, the median value was 0.22-0.27. The results of regression statistical analysis showed that the change of lymphocyte counts significantly associated with the severe degree of secondary injury (P=0.000). The lymphocyte ratio change can be used to predict the possibility of trauma patients secondary severe tissue injury occurred [Area Under the Curve( AUC) on the ratios of the lymphocytes counts in 6-72 hours to that within first 3 hours after trauma was 0.789, 0.840, 0.861, respectively]. The predictive thresholds of lymphocyte ratio of the trauma patients in the study were 0.31 to 0.35, the prediction sensitivity were 78% to 89% and specificity 74% to 84%. The lymphocyte counts there was significant difference between the patients with assessed as serious secondary tissue injury(87cases) and patients without(25 cases), the median value was 0.21-0.24 , 0.38-0.62, respectively , P=0.000. Conclusion: Lymphocytes counts was significantly increased in the trauma patients with ISS score ≥16 within the first 3 hours after trauma, then decreased significantly in 6-72 hours after trauma. The change of lymphocyte count was significant relationship with the degree of secondary tissue injury, that can be used to predict the degree of secondary severe tissue injury occurred by inflammatory reaction in trauma patients.

Prediction of venous thromboembolism using clinical and serum biomarker data from a military cohort of trauma patients

2020 ◽  
pp. bmjmilitary-2019-001393 ◽  
Author(s):  
Matthew Bradley ◽  
A Shi ◽  
V Khatri ◽  
S Schobel ◽  
E Silvius ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Injury Severity ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Area Under The Curve ◽  
Serum Biomarkers ◽  
Trauma Patients ◽  
Total Blood ◽  
Mortality And Morbidity ◽  
Clinical Measures

IntroductionVenous thromboembolism (VTE) is a frequent complication of trauma associated with high mortality and morbidity. Clinicians lack appropriate tools for stratifying trauma patients for VTE, thus have yet to be able to predict when to intervene. We aimed to compare random forest (RF) and logistic regression (LR) predictive modelling for VTE using (1) clinical measures alone, (2) serum biomarkers alone and (3) clinical measures plus serum biomarkers.MethodsData were collected from 73 military casualties with at least one extremity wound and prospectively enrolled in an observational study between 2007 and 2012. Clinical and serum cytokine data were collected. Modelling was performed with RF and LR based on the presence or absence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). For comparison, LR was also performed on the final variables from the RF model. Sensitivity/specificity and area under the curve (AUC) were reported.ResultsOf the 73 patients (median Injury Severity Score=16), nine (12.3%) developed VTE, four (5.5%) with DVT, four (5.5%) with PE, and one (1.4%) with both DVT and PE. In all sets of predictive models, RF outperformed LR. The best RF model generated with clinical and serum biomarkers included five variables (interleukin-15, monokine induced by gamma, vascular endothelial growth factor, total blood products at resuscitation and presence of soft tissue injury) and had an AUC of 0.946, sensitivity of 0.992 and specificity of 0.838.ConclusionsVTE may be predicted by clinical and molecular biomarkers in trauma patients. This will allow the development of clinical decision support tools which can help inform the management of high-risk patients for VTE.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Post-Traumatic Sepsis Is Associated with Increased C5a and Decreased TAFI Levels

2020 ◽  
Vol 9 (4) ◽  
pp. 1230 ◽  
Author(s):  
Jan Tilmann Vollrath ◽  
Ingo Marzi ◽  
Anna Herminghaus ◽  
Thomas Lustenberger ◽  
Borna Relja
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Area Under The Curve ◽  
Statistical Correlation ◽  
Sepsis Group ◽  
Coagulation System ◽  
Trauma Patients ◽  
Inflammatory Factor ◽  
Correlation Analyses ◽  
Post Traumatic

Background: Sepsis frequently occurs after major trauma and is closely associated with dysregulations in the inflammatory/complement and coagulation system. Thrombin-activatable fibrinolysis inhibitor (TAFI) plays a dual role as an anti-fibrinolytic and anti-inflammatory factor by downregulating complement anaphylatoxin C5a. The purpose of this study was to investigate the association between TAFI and C5a levels and the development of post-traumatic sepsis. Furthermore, the predictive potential of both TAFI and C5a to indicate sepsis occurrence in polytraumatized patients was assessed. Methods: Upon admission to the emergency department (ED) and daily for the subsequent ten days, circulating levels of TAFI and C5a were determined in 48 severely injured trauma patients (injury severity score (ISS) ≥ 16). Frequency matching according to the ISS in septic vs. non-septic patients was performed. Trauma and physiologic characteristics, as well as outcomes, were assessed. Statistical correlation analyses and cut-off values for predicting sepsis were calculated. Results: Fourteen patients developed sepsis, while 34 patients did not show any signs of sepsis (no sepsis). Overall injury severity, as well as demographic parameters, were comparable between both groups (ISS: 25.78 ± 2.36 no sepsis vs. 23.46 ± 2.79 sepsis). Septic patients had significantly increased C5a levels (21.62 ± 3.14 vs. 13.40 ± 1.29 ng/mL; p < 0.05) and reduced TAFI levels upon admission to the ED (40,951 ± 5637 vs. 61,865 ± 4370 ng/mL; p < 0.05) compared to the no sepsis group. Negative correlations between TAFI and C5a (p = 0.0104) and TAFI and lactate (p = 0.0423) and positive correlations between C5a and lactate (p = 0.0173), as well as C5a and the respiratory rate (p = 0.0266), were found. In addition, correlation analyses of both TAFI and C5a with the sequential (sepsis-related) organ failure assessment (SOFA) score have confirmed their potential as early sepsis biomarkers. Cut-off values for predicting sepsis were 54,857 ng/mL for TAFI with an area under the curve (AUC) of 0.7550 (p = 0.032) and 17 ng/mL for C5a with an AUC of 0.7286 (p = 0.034). Conclusion: The development of sepsis is associated with early decreased TAFI and increased C5a levels after major trauma. Both elevated C5a and decreased TAFI may serve as promising predictive factors for the development of sepsis after polytrauma.

Plasma ADAMTS13 Activity Associates with Injury Severity in Pediatric Trauma Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3777-3777
Author(s):  
Jenny K. McDaniel ◽  
Ilan I Maizlin ◽  
Michelle C. Shroyer ◽  
Morgan E. Banks ◽  
Jean-Francois Pittet ◽  
...  
Keyword(s):  
Injury Severity ◽  
Pediatric Trauma ◽  
Initial Presentation ◽  
Trauma Patients ◽  
Adamts13 Activity ◽  
Acute Traumatic Coagulopathy ◽  
Time Period ◽  
Increased Risk ◽  
Significant Difference ◽  
Traumatic Coagulopathy

Abstract Background: Acute traumatic coagulopathy occurs in both pediatric and adult trauma patients and is associated with an increased risk of mortality. Trauma patients not only have increased risk for hemorrhagic complications, but also are at increased risk for thrombosis due to multiple factors including local tissue injury, inflammation, and immobility. The complex underlying pathophysiology of coagulation abnormalities associated with traumatic injury have yet to be fully elucidated. Additionally, there are significant differences in the hemostatic system of pediatric patients compared to adults. Objectives: The purpose of this study was to determine the levels of coagulation parameters including von Willebrand factor (VWF) antigen and ADAMTS13 activity in pediatric trauma patients and evaluate for possible association with injury severity and/or mortality. Methods: This study utilized plasma specimens collected from pediatric trauma patients that presented to our institution over a 2-year time period. The specimens were collected at initial presentation and 24 hours later. The injury severity was estimated using both the Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). A cohort of control samples was obtained from pediatric patients for elective surgical procedures over the same time period. Plasma VWF antigen was determined by a sandwich ELISA; plasma ADAMTS13 activity was determined by FRETS-VWF73. The results were determined by nonparametric tests for the differences in median values. Results: A total of 106 trauma patient samples at initial time point, 78 trauma samples at 24 hour time point, and 54 control samples were obtained and utilized for study. There were statistically significant differences (p<0.05) in the plasma levels of VWF antigen, ADAMTS13 activity, and the ratio of ADAMTS13 activity to VWF antigen for the trauma patient samples at initial presentation when compared to controls (Table 1). At 24 hours, there were still statistically significant differences between ADAMTS13 activity and the ratio of ADAMTS13 activity to VWF antigen in trauma patients compared to controls, but there was no significant difference in VWF antigen between the two cohorts (Table 2). There was a significant difference between the decrease in ADAMTS13 activity and injury severity as estimated by ISS ³ 15 or GCS < 8 at both time points; however, ADAMTS13 activity was not statistically different in survivors vs. non-survivors. A higher VWF antigen level at initial presentation was the only factor found to be significantly different in non-survivors. Conclusions: This study demonstrates significant differences in plasma ADAMTS13 activity and VWF antigen in pediatric trauma patients compared to controls. In patients with more severe injuries as estimated by GCS and ISS, there was also a significant association with decreased levels of ADAMTS13 activity. These finding may underlie part of the prothrombotic propensity in microcirculation that occurs in patients post-trauma. Further investigation is warranted to better understand the mechanisms of acute traumatic coagulopathy and potential prognostic factors, and to determine the most effective interventions for acute traumatic coagulopathy in the pediatric population. Disclosures Zheng: Ablynx: Consultancy; Alexion: Research Funding.

scholarly journals The significance of the levels of fibrin/fibrinogen degradation products for predicting trauma severity

2018 ◽  
Vol 26 (3) ◽  
pp. 143-150 ◽  
Author(s):  
Masato Murata ◽  
Shuichi Hagiwara ◽  
Makoto Aoki ◽  
Jun Nakajima ◽  
Kiyohiro Oshima
Keyword(s):  
Injury Severity Score ◽  
Emergency Room ◽  
Severity Score ◽  
Injury Severity ◽  
Degradation Products ◽  
Area Under The Curve ◽  
Trauma Patients ◽  
Fibrinogen Degradation Products ◽  
Trauma Severity ◽  
D Dimer

Background: On initial treatment in the emergency room, trauma patients should be assessed using simple clinical indicators that can be measured quickly. Objectives: The purpose of this study is to investigate the relationship between the injury severity score and blood test parameters measured on emergency room arrival in trauma patients. Methods: Trauma patients transferred to Gunma University Hospital between May 2013 and April 2014 were evaluated in this prospective, observational study. Blood samples were collected immediately on their arrival at our emergency room and their hematocrit, platelet, international normalized ratio of prothrombin time, activated partial thromboplastin time, fibrin/fibrinogen degradation products, and D-dimer were measured. We evaluated the correlations between the injury severity score and those biomarkers, and examined whether the correlation varied according to the injury severity score value. We also evaluated the correlations between the biomarkers and the abbreviated injury scale values of six regions. Results: We analyzed 371 patients. Fibrin/fibrinogen degradation products and D-dimer showed the greatest coefficients of correlation with injury severity score (0.556 and 0.543, respectively). The area under the curve of the receiver operating characteristic was larger in patients with injury severity score ⩾ 9 than in those with injury severity score ⩾ 4; however, patients with injury severity score ⩾ 9 or ⩾16 showed no significant differences. The area under the curve of fibrin/fibrinogen degradation products was larger than that of D-dimer at all injury severity score values. The chest abbreviated injury scale had the strongest relationship with fibrin/fibrinogen degradation products. Conclusion: Fibrin/fibrinogen degradation products and D-dimer were positively correlated with injury severity score, and the relationships varied according to trauma severity. Chest trauma contributed most strongly to fibrin/fibrinogen degradation product elevation.

scholarly journals Impact of stress-induced hyperglycemia on the outcome of children with trauma: A cross-sectional analysis based on propensity score-matched population

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yi-Wen Tsai ◽  
Shao-Chun Wu ◽  
Chun-Ying Huang ◽  
Shiun-Yuan Hsu ◽  
Hang-Tsung Liu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of ◽  
Sectional Analysis

Abstract This was a retrospective study of pediatric trauma patients and were hospitalized in a level-1 trauma center from January 1, 2009 to December 31, 2016. Stress-induced hyperglycemia (SIH) was defined as a hyperglycemia level ≥200 mg/dL upon arrival at the emergency department without any history of diabetes or a hemoglobin A1c level ≥6.5% upon arrival or during the first month of admission. The results demonstrated that the patients with SIH (n = 36) had a significantly longer length of stay (LOS) in hospital (16.4 vs. 7.8 days, p = 0.002), higher rates of intensive care unit (ICU) admission (55.6% vs. 20.9%, p < 0.001), and higher in-hospital mortality rates (5.6% vs. 0.6%, p = 0.028) compared with those with non-diabetic normoglycemia (NDN). However, in the 24-pair well-balanced propensity score-matched patient populations, in which significant difference in sex, age, and injury severity score were eliminated, patient outcomes in terms of LOS in hospital, rate of ICU admission, and in-hospital mortality rate were not significantly different between the patients with SIH and NDN. The different baseline characteristics of the patients, particularly injury severity, may be associated with poorer outcomes in pediatric trauma patients with SIH compared with those with NDN. This study also indicated that, upon major trauma, the response of pediatric patients with SIH is different from that of adult patients.

Percutaneous versus Open Tracheostomy in the Pediatric Trauma Population

2010 ◽  
Vol 76 (3) ◽  
pp. 276-278 ◽  
Author(s):  
Ashish Raju ◽  
D'Andrea K. Joseph ◽  
Cheickna Diarra ◽  
Steven E. Ross
Keyword(s):  
Injury Severity ◽  
Percutaneous Tracheostomy ◽  
Pediatric Trauma ◽  
Retrospective Chart Review ◽  
Feeding Tube ◽  
Tube Placement ◽  
Trauma Patients ◽  
Complication Rates ◽  
Trauma Population ◽  
Significant Difference

The purpose of this study was to determine the safety and efficacy of percutaneous versus open tracheostomy in the pediatric trauma population. A retrospective chart review was conducted of all tracheostomies performed on trauma patients younger than 18 years for an 8-year period. There was no difference in the incidence of brain, chest, or facial injury between the open and percutaneous tracheostomy groups. However, the open group had a significantly lower age (14.2 vs. 15.5 years; P < 0.01) and higher injury severity score (26 vs. 21; P = 0.015). Mean time from injury to tracheostomy was 9.1 days (range, 0 to 16 days) and was not different between the two methods. The majority of open tracheostomies were performed in the operating room and, of percutaneous tracheostomies, at the bedside. Concomitant feeding tube placement did not affect complication rates. There was not a significant difference between complication rates between the two methods of tracheostomy (percutaneous one of 29; open three of 20). Percutaneous tracheostomy can be safely performed in the injured older child.

scholarly journals Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict All-Cause Mortality in Acute Pulmonary Embolism

2020 ◽  
Vol 26 ◽  
pp. 107602961990054 ◽  
Author(s):  
Trung Phan ◽  
Yevgeniy Brailovsky ◽  
Jawed Fareed ◽  
Debra Hoppensteadt ◽  
Omer Iqbal ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Prediction Models ◽  
Area Under The Curve ◽  
Neutrophil To Lymphocyte Ratio ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Useful Components ◽  
Significant Difference ◽  
All Cause Mortality

The aim of this study was to investigate the utility of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) to predict all-cause mortality in patients presenting with acute pulmonary embolism (PE). Three hundred consecutive patients with acute PE between March 2016 and December 2018 were retrospectively analyzed. We identified 191 patients who met the study inclusion criteria. Twenty-eight patients died during the study period. There was a significant difference in PLR, but not NLR, between patients with low risk, submassive, and massive risk PE ( P = .02 and P = .58, respectively, by the Kruskal-Wallis test). Elevated NLR and PLR were associated with all-cause mortality ( P < .01 and P < .01, respectively). Neutrophil-to-lymphocyte ratio of 5.46 was associated with all-cause mortality with sensitivity of 75.0% and specificity of 66.9% (area under the curve [AUC]: 0.692 [95% confidence interval, CI]: 0.568-0.816); P < .01). Platelet-to-lymphocyte ratio of 256.6 was associated with all-cause mortality with sensitivity of 53.6% and specificity of 82.2% (AUC: 0.693 [95% CI: 0.580-0.805]; P < .01). Neutrophil-to-lymphocyte ratio and PLR are simple biomarkers that are readily available from routine laboratory values and may be useful components of PE risk prediction models.

scholarly journals Impact of Low Fibrinogen Levels in the Puzzle of Traumainduced Coagulopathy: Is This the Missing Link?

2013 ◽  
Vol 2 (2) ◽  
pp. 74-79
Author(s):  
Peter Meade ◽  
Juan C Duchesne ◽  
Timothy S Park ◽  
Eric Simms ◽  
Jordan RH Hoffman ◽  
...  
Keyword(s):  
Injury Severity ◽  
Fibrinogen Level ◽  
Tissue Injury ◽  
Damage Control ◽  
Base Deficit ◽  
Stepwise Logistic Regression ◽  
Missing Link ◽  
Trauma Induced Coagulopathy ◽  
Severe Tissue ◽  
Overall Mortality

ABSTRACT Background Patients with severe tissue injury and tissue hypoperfusion can present with low fibrinogen levels and signs of hyperfibrinolysis. The role of damage control resuscitation (DCR) in addressing the hyperfibrinolytic aspect of trauma induced coagulopathy (TIC) is unknown. We hypothesize a survival advantage when DCR is used in TIC patients with severe tissue injury and low fibrinogen levels. Materials and methods This is a 2 years prospective observational study of TIC patients who received DCR. TIC was defined as initial base deficit = –6 in combination with ISS = 12. Low fibrinogen was considered when serum level <200 mg/dl. Patients were stratified into those with an injury severity score (ISS) <20, and those with an ISS = 20. Variables analyzed between groups included: initial serum fibrinogen, INR, base deficit, intraoperative FFP: PRBC ratio and mortality. Results Of 67 patients with TIC, 29 (43.2%) had ISS < 20, and 38 (56.7%) an ISS ≥ 20. Mean ISS was 13.9 vs 32.8 (p < 0.0001) for the ISS < 20 group vs the ISS ≥ 20 group respectively. Mean initial fibrinogen levels for the ISS < 20 group vs the ISS ≥ 20 group was 357.4 mg/dl vs 148.5 mg/dl (p = 0.0007). Intraoperative DCR with FFP: PRBC for the ISS < 20 group vs the ISS ≥ 20 group showed no statistical difference: 1 to 1.12 vs 1 to 1.3 (p = 0.12). Overall mortality after controlling for DCR in the ISS < 20 group was 29 and 73% in the ISS ≥ 20 group (p = 0.0007). In a stepwise logistic regression, low fibrinogen levels was associated with mortality, p = 0.01; OR 1.01 (1.23-11.55) with area under the receiver operating characteristic curve of 0.701. The correlation coefficient for ISS vs initial fibrinogen level was –0.5635 (p = 0.0001). Conclusion Overall mortality was significantly increased in patients who had an ISS . 20 with low fibrinogen level despite effective DCR. Given the correlated decrease in fibrinogen levels in patients with severe tissue injury, further investigation regarding potential benefits of antifibrinolytic agents in DCR needs further validation. How to cite this article Duchesne JC, Guidry C, Park TS, Simms E, Hoffman JRH, Bock JM, Wascom J, Barbeau J, Meade P, McSwain NE Jr. Impact of Low Fibrinogen Levels in the Puzzle of Trauma-induced Coagulopathy: Is This the Missing Link? Panam J Trauma Critical Care Emerg Surg 2013;2(2): 74-79.

scholarly journals Association between neutrophil to lymphocyte ratio and mortality among community acquired pneumonia patients: a meta-analysis

2021 ◽  
Author(s):  
Osama Alzoubi ◽  
Asim Khanfar
Keyword(s):  
Early Stage ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Community Acquired Pneumonia ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Prognostic Accuracy ◽  
Significant Difference ◽  
Standardized Mean Difference ◽  
Routine Assessment

The neutrophil to lymphocyte ratio (NLR)is an emerging biomarker used in the prognosis of many conditions. We aimed to conduct a meta-analysis to assess the prognostic accuracy of the NLR in determining mortality in patients with Community acquired pneumonia (CAP). The Pubmed, EBSCO, and Scopus databases were searched to find all relevant articles. 10 articles with 5220 patients were included. The pooled area under the curve (AUC) of NLR admission levels to predict 30-Day mortality of CAP patients was 0.706; 95% CI (0.631 to 0.781), while the pooled AUC of NLR levels taken at 3-5 days was 0.882; 95% CI (0.818 to 0.945). Meta analysis also showed a significant difference in the NLR between the Survivors and 30-Day non-survivors. This difference was greater when NLR levels were taken at 3-5 days; Standardized mean difference (SMD) = 1.646; 95% CI (0.451 to 2.840) compared to NLR levels at admission SMD = 1.139; 95% CI (0.514 to 1.764). These results show that the NLR has potential to be incorporated in the routine assessment and stratification of CAP patients, especially in the early-stage evolution (3-5 days), keeping in mind the availability and cost effectiveness of this test.

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