Neutrophil-to-Lymphocyte Ratio Improves the Accuracy and Sensitivity of Pneumonia Severity Index in Predicting 30-Day Mortality of CAP Patients

2019 ◽  
Vol 65 (10/2019) ◽  
Author(s):  
Hai Zhang ◽  
Yan Ge ◽  
Hong Wang ◽  
Qian Zhang ◽  
Wen Li ◽  
...  
Keyword(s):  
Pneumonia Severity Index ◽  
Severity Index ◽  
Neutrophil To Lymphocyte Ratio ◽  
Pneumonia Severity ◽  
Lymphocyte Ratio

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 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 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.

Perbandingan Expanded Curb-65 Terhadap Curb-65 dan Psi Dalam Memprediksi Luaran Pasien Cap

2019 ◽  
Vol 4 (3) ◽  
pp. 608
Author(s):  
Suyastri Suyastri ◽  
Irvan Medison ◽  
Deddy Herman ◽  
Russilawati Russilawati
Keyword(s):  
Logistic Regression ◽  
Multivariate Analysis ◽  
Prospective Study ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Accurate Method ◽  
P Value ◽  
Pneumonia Severity ◽  
Advantages And Disadvantages ◽  
Care Decision

<p><em>Tingkat keparahan CAP adalah poin penting pengambilan keputusan perawatan pasien. Beberapa metode telah digunakan untuk menilai tingkat keparahan pneumonia seperti Pneumonia Severity Index (PSI), CURB-65, SMART-COP dan Expanded CURB-65. Metode tersebut memiliki kelebihan dan kekurangan. Expanded CURB 65 diusulkan menjadi metode yang lebih akurat untuk mengevaluasi keparahan pneumonia dan memprediksi kematian pasien CAP. Tujuan penelitian ini memprediksi keakuratan Expanded CURB  65 dibandingkan CURB 65 dan PSI. Penelitian kohort prospektif pada pasien CAP yang dirawat di RSUP Dr. M.Djamil Padang dari April sampai Oktober 2019. Tingkat keparahan CAP pada pasien dinilai menggunakan PSI, CURB 65, Expanded CURB 65, kemudian hasilnya dievaluasi berdasarkan keparahan. Data dianalisis menggunakan regresi logistik dengan CI 95% dan nilai p &lt;0,05 dianggap signifikan. Hasil penelitian pada 90 pasien sebagian besar laki-laki usia 53 tahun dengan komorbiditas terbanyak keganasan. Uji Pearson Chi aquare menunjukkan tidak ada hubungan antara tingkat keparahan berdasarkan CURB 65 dan luaran pengobatan (CI 95%, nilai p = 0,104). Sementara, PSI dan Expanded CURB 65 memiliki hubungan yang signifikan antara tingkat keparahan dan luaran (CI 95%, p=0,081 dan CI 95%, p= 0,046, masing-masing). Analisis multivariat menemukan Expanded CURB 65 lebih akurat dalam memprediksi luaran pasien CAP rawat inap (kappa =0,108 dan AUC=0,422).</em></p><p><em><br /></em></p><p><em><em>Severity of CAP is very important for site care decision inpatients. Several methods have been used to assess the severity of pneumonia such as Pneumonia Severity Index (PSI), CURB-65, SMART-COP and Expanded CURB-65. Those methods have advantages and disadvantages. Expanded CURB 65 is proposed to be more accurate method for evaluating pneumonia severity and predicting mortality in CAP. The aim of this study was to investigate the accuracy of Expanded CURB 65 compare to CURB 65 and PSI. Cohort prospective study was conducted for CAP patients who were hospitalized at RSUP Dr. M.Djamil Padang from April to October 2019. Patients was assesed for severity using PSI, CURB 65, Expanded CURB 65, then we evaluated it’s outcome. The data were analyzed by logistic regression with CI 95% and p value &lt;0,05 considered as statistically significant. We found 90 patients that predominantly males with an average age of 53 years, and the most common comorbidity is malignancy. There was no relationship between pneumonia severity by CURB 65 and outcome (CI 95%, p=0.104). PSI and Expanded CURB 65 had significant relationship between severity and outcome (CI 95%, p=0.081and CI 95%, p=0.046, respectively). Multivariate analysis showed the expanded CURB 65 was more accurate for predicting the outcome of CAP inpatients (kappa=0.108 and AUC= 0.422).</em></em></p>

Soluble form of suppression of tumorigenicity-2 predicts clinical stability of inpatients with community-acquired pneumonia

2021 ◽  
pp. 153537022110271
Author(s):  
Yifeng Zeng ◽  
Mingshan Xue ◽  
Teng Zhang ◽  
Shixue Sun ◽  
Runpei Lin ◽  
...  
Keyword(s):  
Regression Model ◽  
Predictive Value ◽  
Cox Regression ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Risk Classification ◽  
Soluble Form ◽  
Pneumonia Severity ◽  
Clinical Stability

The soluble form of the suppression of tumorigenicity-2 (sST2) is a biomarker for risk classification and prognosis of heart failure, and its production and secretion in the alveolar epithelium are significantly correlated with the inflammation-inducing in pulmonary diseases. However, the predictive value of sST2 in pulmonary disease had not been widely studied. This study investigated the potential value in prognosis and risk classification of sST2 in patients with community-acquired pneumonia. Clinical data of ninety-three CAP inpatients were retrieved and their sST2 and other clinical indices were studied. Cox regression models were constructed to probe the sST2’s predictive value for patients’ restoring clinical stability and its additive effect on pneumonia severity index and CURB-65 scores. Patients who did not reach clinical stability within the defined time (30 days from hospitalization) have had significantly higher levels of sST2 at admission ( P <  0.05). In univariate and multivariate Cox regression analysis, a high sST2 level (≥72.8 ng/mL) was an independent reverse predictor of clinical stability ( P < 0.05). The Cox regression model combined with sST2 and CURB-65 (AUC: 0.96) provided a more accurate risk classification than CURB-65 (AUC:0.89) alone (NRI: 1.18, IDI: 0.16, P < 0.05). The Cox regression model combined with sST2 and pneumonia severity index (AUC: 0.96) also provided a more accurate risk classification than pneumonia severity index (AUC:0.93) alone (NRI: 0.06; IDI: 0.06, P < 0.05). sST2 at admission can be used as an independent early prognostic indicator for CAP patients. Moreover, it can improve the predictive power of CURB-65 and pneumonia severity index score.

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