Che-Morales José Luis, Cortes-Telles Arturo
Instituto Mexicano del Seguro Social, Unidad Médica de Atención Ambulatoria 01, Servicio de Neumología e Inhaloterapia. Mérida, Yucatán, México.
Rev Med Inst Mex Seguro Soc. 2019 Mar 15;56(6):537-543.
Community acquired pneumonia (CAP) is the main infectious cause of mortality in the world. Several scales evaluates outcomes, however the current tendency favors using biomarkers as surrogates of clinical prognosis.
To evaluate utility of neutrophil-to-lymphocyte ratio to identify severe patients according to Pneumonia Severity Index scale.
Observational and retrospective study in adults ≥18 years old with CAP, evaluated in an emergency ward of a secondary level hospital. Demography, laboratory results, treatment and Pneumonia Severity Index scale (PSI) data were collected. The neutrophil-to-lymphocyte ratio (NLR) between two groups was compared, high risk vs. low risk of complications according to PSI.
94 patients were studied. There were not differences in tobacco smoking, comorbidities and outcomes between groups. Neutrophil total count, lymphopenia, and NLR were more elevated in the high risk group (p < 0.05). Uni and multivariate analysis showed that neutrophils and NLR could be surrogate of PSI III or higher (OR: 1.05 and 1.14 respectively). A NLR value ≥ 7.2 provided that probability (AUC 0.65; IC 95% 0.53-0.78).
NLR is useful to identify patients with grave pneumonia and risk of complications according to PSI.
社区获得性肺炎（CAP）是全球主要的感染性死亡原因。有多种量表可评估预后，然而目前的趋势倾向于使用生物标志物作为临床预后的替代指标。
根据肺炎严重程度指数量表，评估中性粒细胞与淋巴细胞比值用于识别重症患者的效用。
对一家二级医院急诊科就诊的≥18岁成人CAP患者进行观察性回顾性研究。收集人口统计学、实验室检查结果、治疗情况及肺炎严重程度指数量表（PSI）数据。比较两组间的中性粒细胞与淋巴细胞比值（NLR），根据PSI分为并发症高风险组和低风险组。
共研究94例患者。两组在吸烟、合并症及预后方面无差异。高风险组的中性粒细胞总数、淋巴细胞减少及NLR更高（p<0.05）。单因素和多因素分析显示，中性粒细胞和NLR可作为PSI III级或更高等级的替代指标（OR分别为1.05和1.14）。NLR值≥7.2时具有该概率（AUC 0.65；95%CI 0.53 - 0.78）。
NLR有助于根据PSI识别重症肺炎及有并发症风险的患者。
