开发肺炎优化比用于社区获得性肺炎：一种简便、廉价且准确的预后生物标志物。
Developing the Pneumonia-Optimized Ratio for Community-acquired pneumonia: An easy, inexpensive and accurate prognostic biomarker.
机构信息
School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
出版信息
PLoS One. 2021 Mar 23;16(3):e0248897. doi: 10.1371/journal.pone.0248897. eCollection 2021.
INTRODUCTION
Community-acquired pneumonia (CAP) is still a major public health problem. Prognostic scores at admission in tertiary services may improve early identification of severity and better allocation of resources, ultimately improving survival. Herein, we aimed at evaluating prognostic biomarkers of CAP and a Pneumonia-Optimized Ratio was created to improve prognostic performance.
METHODS
In this retrospective study, all patients with suspected Community-acquired pneumonia aged 18 or older admitted to a public hospital from January 2019 to February 2020 were included in this study. Blood testing and clinical information at admission were collected, and the primary outcome was overall survival. CURB-65 scores and prognostic biomarkers were measured, namely Neutrophil-to-Lymphocyte Cell Ratio (NLCR), Platelet to Lymphocyte ratio (PLR), Monocyte to Lymphocyte Ratio (MLR). A Pneumonia-Optimized Ratio (POR) score was created by selecting the biomarker with larger accuracy (NLCR) and multiplying it by the patients' CURB-65 score. Multivariate regression model was performed and ROC curves were created for each biomarker.
RESULTS
Our sample consisted of 646 individuals (median 66 years [IQR, 18-103], 53.9% females) with complete blood testing at the time of admission. Patients scored 0-1 (323, 50%), 2 (187, 28.9%), or 3 or above (122, 18.9%) in the CURB-65, and 65 (10%) presented the primary outcome of death. POR exhibited the highest Area Under Curve (AUC) in the ROC analysis (AUC = 0.753), when compared with NLCR (AUC = 0.706), PLR (AUC = 0.630) and MLR (AUC = 0.627). POR and NLCR presented increased crude mortality rate in the fourth quartile in comparison with the first quartile, and the fourth quartile of NLCR had more days of hospitalization than the first quartile (11.06±15.96 vs. 7.02±8.39, p = 0.012).
CONCLUSION
The Pneumonia-Optimized Ratio in patients with CAP showed good prognostic performance of mortality at the admission of a tertiary service. The NLCR may also be used as an estimation of days of hospitalization. Prognostic biomarkers may provide important guidance to resource allocation in resource-limited settings.
介绍
社区获得性肺炎（CAP）仍然是一个主要的公共卫生问题。在三级服务中，入院时的预后评分可以提高对严重程度的早期识别，并更好地分配资源，最终提高生存率。在此，我们旨在评估 CAP 的预后生物标志物，并创建肺炎优化比值（Pneumonia-Optimized Ratio，POR）以提高预后性能。
方法
本回顾性研究纳入了 2019 年 1 月至 2020 年 2 月期间在一家公立医院就诊的所有年龄在 18 岁或以上的疑似社区获得性肺炎患者。收集入院时的血液检测和临床信息，主要结局为总生存率。测量 CURB-65 评分和预后生物标志物，即中性粒细胞与淋巴细胞比值（Neutrophil-to-Lymphocyte Cell Ratio，NLCR）、血小板与淋巴细胞比值（Platelet to Lymphocyte ratio，PLR）、单核细胞与淋巴细胞比值（Monocyte to Lymphocyte Ratio，MLR）。通过选择准确性更高的生物标志物（NLCR）并乘以患者的 CURB-65 评分，创建了肺炎优化比值（POR）评分。进行多变量回归模型分析，并为每个生物标志物绘制 ROC 曲线。
结果
我们的样本包括 646 名患者（中位数 66 岁[IQR，18-103]，53.9%为女性），在入院时进行了完整的血液检测。患者的 CURB-65 评分为 0-1（323 例，50%）、2（187 例，28.9%）或 3 分或以上（122 例，18.9%），65 例（10%）出现了主要结局的死亡。POR 在 ROC 分析中的曲线下面积（Area Under Curve，AUC）最高（AUC=0.753），而 NLCR（AUC=0.706）、PLR（AUC=0.630）和 MLR（AUC=0.627）。与第一四分位相比，POR 和 NLCR 在第四四分位的死亡率更高，而 NLCR 的第四四分位的住院天数多于第一四分位（11.06±15.96 与 7.02±8.39，p=0.012）。
结论
在三级服务中，CAP 患者的肺炎优化比值显示出良好的入院时死亡率预后性能。NLCR 也可用于估计住院天数。预后生物标志物可为资源有限环境下的资源分配提供重要指导。
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