Qiu Yue, Su Ying, Tu Guo-Wei, Ju Min-Jie, He Hong-Yu, Gu Zhun-Yong, Yang Cheng, Luo Zhe
Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Pathogens. 2020 Nov 4;9(11):913. doi: 10.3390/pathogens9110913.
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, < 0.001). NLR had the greatest power to predict mortality as suggested by area under the curve (0.88 ± 0.04; < 0.0001) compared to platelet-to-lymphocyte ratio (0.75 ± 0.06; < 0.01), pneumonia severity index (0.65 ± 0.08; = 0.05), CURB-65 (0.65 ± 0.08; = 0.05), and neutrophil count (0.68 ± 0.07; < 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.
尽管重症监护管理有所进步，但肾移植受者发生严重社区获得性肺炎（CAP）后的死亡率仍然很高。目前仍缺乏预测这些患者预后的生物标志物。本研究旨在探讨中性粒细胞与淋巴细胞比值（NLR）与肾移植受者严重CAP死亡率之间的关联。2009年1月1日至2018年11月30日期间，对111例入住重症监护病房（ICU）的肾移植严重CAP受者进行了资格筛查。回顾性收集了患者入住ICU时的特征和实验室检查结果。最终纳入的81例严重CAP患者中有18例死亡（22.2%）。死亡患者的NLR水平高于存活患者（26.8对12.3，<0.001）。与血小板与淋巴细胞比值（0.75±0.06；<0.01）、肺炎严重程度指数（0.65±0.08；=0.05）、CURB-65（0.65±0.08；=0.05）和中性粒细胞计数（0.68±0.07；<0.01）相比，NLR预测死亡率的能力最强，曲线下面积显示为（0.88±0.04；<0.0001）。多因素逻辑回归模型显示，NLR与肾移植严重CAP受者的医院死亡率和ICU死亡率相关。NLR水平与死亡率独立相关，可能是预测肾移植严重CAP受者不良结局的有用生物标志物。
