Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China.
Sci Rep. 2022 Sep 24;12(1):15974. doi: 10.1038/s41598-022-20385-3.
The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) are emerging biomarkers to predict outcomes in general ward patients. However, their role in the prognostication of critically ill patients with pneumonia is unclear. A total of 216 adult patients were enrolled over 2 years. They were classified into viral and bacterial pneumonia groups, as represented by influenza A virus and Streptococcus pneumoniae, respectively. Demographics, outcomes, and laboratory parameters were analysed. The prognostic power of blood parameters was determined by the respective area under the receiver operating characteristic curve (AUROC). Performance was compared using the APACHE IV score. Discriminant ability in differentiating viral and bacterial aetiologies was examined. Viral and bacterial pneumonia were identified in 111 and 105 patients, respectively. In predicting hospital mortality, the APACHE IV score was the best prognostic score compared with all blood parameters studied (AUC 0.769, 95% CI 0.705-0.833). In classification tree analysis, the most significant predictor of hospital mortality was the APACHE IV score (adjusted P = 0.000, χ = 35.591). Mechanical ventilation was associated with higher hospital mortality in patients with low APACHE IV scores ≤ 70 (adjusted P = 0.014, χ = 5.999). In patients with high APACHE IV scores > 90, age > 78 (adjusted P = 0.007, χ = 11.221) and thrombocytopaenia (platelet count ≤ 128, adjusted P = 0.004, χ = 12.316) were predictive of higher hospital mortality. The APACHE IV score is superior to all blood parameters studied in predicting hospital mortality. The single inflammatory marker with comparable prognostic performance to the APACHE IV score is platelet count at 48 h. However, there is no ideal biomarker for differentiating between viral and bacterial pneumonia.
中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、血小板与淋巴细胞比值（PLR）和红细胞分布宽度（RDW）是预测普通病房患者结局的新兴生物标志物。然而，它们在预测肺炎危重症患者预后中的作用尚不清楚。在过去 2 年中，共纳入了 216 名成年患者。他们分为病毒和细菌肺炎组，分别由甲型流感病毒和肺炎链球菌代表。分析了人口统计学、结局和实验室参数。通过各自的受试者工作特征曲线（ROC）下面积（AUROC）确定血液参数的预后能力。使用急性生理和慢性健康评估 IV 评分（APACHE IV）进行比较。检查了区分病毒和细菌病因的判别能力。分别确定了 111 例和 105 例病毒性和细菌性肺炎患者。在预测住院死亡率方面，APACHE IV 评分是所有研究血液参数中最佳的预后评分（AUC 0.769，95%CI 0.705-0.833）。在分类树分析中，住院死亡率的最显著预测因素是 APACHE IV 评分（调整后 P=0.000，χ=35.591）。在 APACHE IV 评分≤70 的患者中，机械通气与更高的住院死亡率相关（调整后 P=0.014，χ=5.999）。在 APACHE IV 评分>90 的患者中，年龄>78 岁（调整后 P=0.007，χ=11.221）和血小板减少症（血小板计数≤128，调整后 P=0.004，χ=12.316）是更高住院死亡率的预测因素。APACHE IV 评分在预测住院死亡率方面优于所有研究的血液参数。与 APACHE IV 评分具有相当预后性能的单个炎症标志物是 48 小时血小板计数。然而，目前还没有理想的生物标志物可以区分病毒和细菌肺炎。
