中性粒细胞与淋巴细胞比值在预测社区获得性肺炎患者预后中的作用。

The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia.

作者信息

Sharma Yogesh, Thompson Campbell, Zinellu Angelo, Shahi Rashmi, Horwood Chris, Mangoni Arduino A

机构信息

Senior Consultant Physician, Department of Acute and General Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia; College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia.

Prof Campbell Thompson, Professor of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.

出版信息

Clin Med (Lond). 2025 Jan;25(1):100278. doi: 10.1016/j.clinme.2024.100278. Epub 2024 Dec 12.

DOI:10.1016/j.clinme.2024.100278

PMID:39672544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11731571/

Abstract

OBJECTIVES

The value of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients hospitalised with community-acquired pneumonia (CAP) remains debated. This study evaluated whether NLR independently predicts clinical outcomes and enhances the predictive performance of the CURB-65 score in patients with CAP.

METHODS

Data from CAP admissions at two Australian hospitals from 2018 to 2023 were analysed. NLR was calculated using admission neutrophil and lymphocyte counts. Patients were categorised into NLR >12 and NLR ≤12. Multilevel-multivariable regression models, adjusting for age, sex, Charlson index, CURB-65 score, Hospital Frailty Risk Score (HFRS) and C-reactive protein (CRP), assessed outcomes including length of stay (LOS), intensive care unit (ICU) admission and in-hospital mortality.

RESULTS

Over 6 years, 7,862 patients with CAP were hospitalised (mean age 75.1 years, 54.6% male). Mean NLR was 12.6, with 2,877 (36.6%) patients having an NLR >12. Those with NLR >12 were older males with higher disease severity and Charlson index (p<0.05). Adjusted analyses showed that NLR >12 was independently associated with prolonged LOS (IRR=1.11, 95% CI 1.08-1.13, p<0.001), increased risk of ICU admission (adjusted odds ratio (aOR) =1.41, 95% confidence interval (CI) 1.06-1.88, p=0.019), and higher in-hospital mortality (aOR=1.27, 95% CI 1.06-1.53, p=0.009). The predictive ability of the CURB-65 score for in-hospital mortality was good (area under the curve (AUC) 0.68, 95% CI 0.66-0.70), while it was modest for the NLR (AUC 0.58, 95% CI 0.56-0.60). Incorporation of NLR to the CURB-65 score did not enhance its predictive ability (AUC 0.69, p>0.05).

CONCLUSIONS

NLR independently predicts adverse outcomes in patients hospitalised with CAP but does not improve the predictive performance of the CURB-65 score.

摘要

目的

中性粒细胞与淋巴细胞比值（NLR）在预测社区获得性肺炎（CAP）住院患者预后方面的价值仍存在争议。本研究评估了NLR是否能独立预测临床结局，并增强CURB-65评分对CAP患者的预测性能。

方法

分析了2018年至2023年澳大利亚两家医院CAP入院患者的数据。使用入院时的中性粒细胞和淋巴细胞计数计算NLR。患者被分为NLR>12和NLR≤12两组。采用多水平多变量回归模型，对年龄、性别、Charlson指数、CURB-65评分、医院衰弱风险评分（HFRS）和C反应蛋白（CRP）进行校正，评估包括住院时间（LOS）、重症监护病房（ICU）入住率和院内死亡率等结局。

结果

在6年期间，7862例CAP患者住院（平均年龄75.1岁，男性占54.6%）。平均NLR为12.6，2877例（36.6%）患者的NLR>12。NLR>12的患者为老年男性，疾病严重程度和Charlson指数较高（p<0.05）。校正分析显示，NLR>12与住院时间延长独立相关（风险比（IRR）=1.11，95%置信区间（CI）1.08-1.13，p<0.001），ICU入住风险增加（校正优势比（aOR）=1.41，95%CI 1.06-1.88，p=0.019），以及院内死亡率更高（aOR=1.27，95%CI 1.06-1.53，p=0.009）。CURB-65评分对院内死亡率的预测能力良好（曲线下面积（AUC）0.68，95%CI 0.66-0.70），而NLR的预测能力一般（AUC 0.58，95%CI 0.56-0.60）。将NLR纳入CURB-65评分并未增强其预测能力（AUC 0.69，p>0.05）。