中性粒细胞与淋巴细胞比值：预测老年社区获得性肺炎患者预后的新兴标志物。

Neutrophil-To-Lymphocyte Ratio: An Emerging Marker Predicting Prognosis in Elderly Adults with Community-Acquired Pneumonia.

作者信息

Cataudella Emanuela, Giraffa Chiara M, Di Marca Salvatore, Pulvirenti Alfredo, Alaimo Salvatore, Pisano Marcella, Terranova Valentina, Corriere Thea, Ronsisvalle Maria L, Di Quattro Rosario, Stancanelli Benedetta, Giordano Mauro, Vancheri Carlo, Malatino Lorenzo

机构信息

Unit of Internal Medicine, Department of Clinical and Experimental Medicine, School of Emergency Medicine, University of Catania, Cannizzaro Hospital, Catania, Italy.

Unit of Bioinformatics and Computer Science, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.

出版信息

J Am Geriatr Soc. 2017 Aug;65(8):1796-1801. doi: 10.1111/jgs.14894. Epub 2017 Apr 13.

DOI:10.1111/jgs.14894

PMID:28407209

Abstract

OBJECTIVES

To explore the performance of the neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation that predicts prognosis of several diseases, in a cohort of elderly adults with community-acquired pneumonia (CAP).

DESIGN

Prospective clinical study from January 2014 to July 2016.

SETTING

Unit of Internal Medicine, University of Catania, Catania, Italy.

PARTICIPANTS

Elderly adults admitted for CAP (N = 195).

MEASUREMENTS

Clinical diagnosis of CAP was defined as the presence of a new infiltrate on plain chest radiography or chest computed tomography associated with one or more suggestive clinical features such as dyspnea, hypo- or hyperthermia, cough, sputum production, tachypnea (respiration rate >20 breaths per minute), altered breath sounds on physical examination, hypoxemia (partial pressure of oxygen <60 mmHg), leukocytosis (white blood cell count >10,000/μL). Clinical examination, traditional tests such as Pneumonia Severity Index (PSI); Confusion, Urea, Respiratory rate, Blood pressure, aged 65 and older (CURB-65), and NLR were evaluated at admission. The accuracy and predictive value for 30-day mortality of traditional scores and NLR were compared.

RESULTS

NLR predicted 30-day mortality (P < .001) and performed better than PSI (P < .05), CURB-65, C-reactive protein, and white blood cell count (P < .001) to predict prognosis. No deaths occurred in participants with a NLR of less than 11.12. Thirty-day mortality was 30% in those with a NLR between 11.12% and 13.4% and 50% in those with a NLR between 13.4 and 28.3. All participants with a NLR greater than 28.3 died within 30 days.

CONCLUSIONS

These results would encourage early discharge of individuals with a NLR of less than 11.12, short-term in-hospital care for those with a NLR between 11.12 and 13.4, middle-term hospitalization for those with a NLR between 13.4 and 28.3, and admission to a respiratory intensive care unit for those with a NLR greater than 28.3.

摘要

目的

探讨中性粒细胞与淋巴细胞比值（NLR）这一全身性炎症指标在一组社区获得性肺炎（CAP）老年患者中的表现，该指标可预测多种疾病的预后。

设计

2014年1月至2016年7月的前瞻性临床研究。

地点

意大利卡塔尼亚大学内科病房。

参与者

因CAP入院的老年患者（N = 195）。

测量指标

CAP的临床诊断定义为胸部X线平片或胸部计算机断层扫描出现新的浸润影，并伴有一项或多项提示性临床特征，如呼吸困难、体温过低或过高、咳嗽、咳痰、呼吸急促（呼吸频率>20次/分钟）、体格检查时呼吸音改变、低氧血症（氧分压<60 mmHg）、白细胞增多（白细胞计数>10,000/μL）。入院时进行临床检查、传统检查如肺炎严重程度指数（PSI）、意识模糊、尿素、呼吸频率、血压、年龄≥65岁（CURB - 65）以及NLR评估。比较传统评分和NLR对30天死亡率的准确性和预测价值。

结果

NLR可预测30天死亡率（P <.001），在预测预后方面比PSI（P <.05）、CURB - 65、C反应蛋白和白细胞计数表现更好（P <.001）。NLR小于11.12的参与者无死亡发生。NLR在11.12%至13.4%之间的患者30天死亡率为30%，NLR在13.4至28.3之间的患者为50%。所有NLR大于28.3的参与者在30天内死亡。