Sun Yi, Wang Hong, Gu Minghao, Zhang Xingyu, Han Xiudi, Liu Xuedong
Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital Group, Qingdao, Shandong Province, 266000, People's Republic of China.
School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, 261000, People's Republic of China.
Infect Drug Resist. 2024 Feb 8;17:463-473. doi: 10.2147/IDR.S443045. eCollection 2024.
Data about eosinophil-to-lymphocyte ratio (ELR) and eosinophil-to-monocyte ratio (EMR) in patients with community-acquired pneumonia (CAP) are rare. We aimed to evaluate the role of EMR and ELR in predicting disease severity and mortality in patients with CAP.
A total of 454 patients (76 with severe CAP (SCAP), 378 with non-SCAP) were enrolled from November 18, 2020, and November 21, 2021. Laboratory examination on day 1 after admission was measured. The ELR and EMR values were calculated for patients. Propensity score matching (PSM) was performed to balance potential confounding factors. Binary logistic regression model was fitted to identify the potential risk factors for disease severity and Cox proportional hazards regression model analysis for mortality in CAP. Receiver operating characteristic (ROC) analysis was performed to distinguish disease severity and mortality.
EMR and ELR at admission were significantly lower in SCAP patients than in non-SCAP patients (<0.001). EMR < 0.018 ([OR] = 12.104, 95% CI: 4.970-29.479), neutrophil (NEU) ([OR]=1.098, 95% CI:1.005-1.199), and age ([OR]=1.091, 95% CI:1.054-1.130) were independent risk factors for disease severity of CAP. EMR < 0.032 ([HR] = 5.816, 95% CI: 1.704-9.848) was an independent predictor of in-hospital mortality. Combining EMR or ELR with CRB-65 improved the overall accuracy of disease severity prediction (AUC from 0.894 to 0.937), the same as CURB-65. The area under the curve of EMR (AUC=0.704; 95% CI: 0.582-0.827) to predict in-hospital mortality was higher than that of CURB-65 (AUC=0.619; 95% CI: 0.484-0.754). Otherwise, EMR combined with CRB-65 (AUC=0.721; 95% CI: 0.592-0.851) had significantly higher diagnostic accuracy for in-hospital mortality than that of CURB-65 alone.
EMR combined with CRB-65 was superior to CURB-65 in predicting mortality in patients with CAP. This new combination was simpler and easier to obtain for physicians in clinics or admission, and it was more convenient for early recognition of patients with poor prognoses.
社区获得性肺炎（CAP）患者中嗜酸性粒细胞与淋巴细胞比值（ELR）和嗜酸性粒细胞与单核细胞比值（EMR）的数据较为罕见。我们旨在评估EMR和ELR在预测CAP患者疾病严重程度和死亡率中的作用。
2020年11月18日至2021年11月21日共纳入454例患者（76例重症CAP（SCAP）患者，378例非SCAP患者）。入院后第1天进行实验室检查。计算患者的ELR和EMR值。进行倾向评分匹配（PSM）以平衡潜在的混杂因素。采用二元逻辑回归模型确定疾病严重程度的潜在危险因素，并采用Cox比例风险回归模型分析CAP患者的死亡率。进行受试者工作特征（ROC）分析以区分疾病严重程度和死亡率。
SCAP患者入院时的EMR和ELR显著低于非SCAP患者（<0.001）。EMR<0.018（[OR]=12.104，95%CI：4.970-29.479）、中性粒细胞（NEU）（[OR]=1.098，95%CI：1.005-1.199）和年龄（[OR]=1.091，95%CI：1.054-1.130）是CAP疾病严重程度的独立危险因素。EMR<0.032（[HR]=5.816，95%CI：1.704-9.848）是院内死亡率的独立预测因素。将EMR或ELR与CRB-65相结合可提高疾病严重程度预测的总体准确性（AUC从0.894提高到0.937），与CURB-65相同。EMR预测院内死亡率的曲线下面积（AUC=0.704；95%CI：0.582-0.827）高于CURB-65（AUC=0.619；95%CI：0.484-0.754）。此外，EMR与CRB-65相结合（AUC=0.721；95%CI：0.592-0.851）对院内死亡率的诊断准确性显著高于单独使用CURB-65。
在预测CAP患者死亡率方面，EMR与CRB-65相结合优于CURB-65。这种新的组合对临床医生或入院时的医生来说更简单、更容易获得，并且更便于早期识别预后不良的患者。
