中性粒细胞与淋巴细胞比值对社区获得性肺炎老年患者肺炎严重程度评分及死亡率的预测价值提升。
The improved prediction value of neutrophil to lymphocyte ratio to pneumonia severity scores for mortality in the older people with community-acquired pneumonia.
作者信息
Huang Lixue, Weng Bingxuan, Wang Mengyuan, Weng Jianzhen, Du Xiaoman, Ju Yang, Zhong Xuefeng, Tong Xunliang, Li Yanming
机构信息
Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, China.
Peking University Fifth School of Clinical Medicine, Beijing, China.
出版信息
BMC Geriatr. 2025 Jul 2;25(1):485. doi: 10.1186/s12877-025-06121-2.
OBJECTIVE
We aimed to evaluate whether there is a linear relationship between neutrophil to lymphocyte ratio (NLR) and adverse outcomes in the older hospitalised patients with community-acquired pneumonia (CAP). The performance of adding NLR to current pneumonia severity scores, including CURB-65, CRB-65, A-DROP and SMART-COP, in predicting 30-day mortality was also investigated.
METHODS
This is a secondary analysis based on an existing dataset of an older cohort of CAP, including 812 patients. Clinical and laboratory results on admission were used to calculate the above scores. The primary outcome was 30-day mortality. Baseline characteristics and outcomes were presented grouped by quartile of NLR. Multivariable adjusted logistic regression and restricted cubic spline were used to evaluate the association between NLR and 30-day mortality. Updated systems were developed after adding NLR to the above four scoring systems. Model discrimination was evaluated by the area under receiver operating characteristic curve (AUCs).
RESULTS
Compared with the lowest quartile NLR group, the higher quartile NLR group had an increased risk of 30-day mortality, with a rate of 18.3% (37/202) in the highest quartile. A significant association of NLR with 30-day mortality was found with an odds ratio of 1.017 (95% confidence interval [CI] 1.002-1.032]), but did not persist after adjustment for age, sex, and comorbidities. A non-linear positive association was observed for NLR with 30-day mortality, with an accelerating mortality rate up to 16 of NLR. The optimal cut-off value of NLR for predicting 30-day mortality was 6.5, which was used to update the scoring systems by adding NLR. The AUCs after updating in the four systems were all significantly improved (all p < 0.05), with the highest AUC of 0.847 (95%CI 0.804-0.891) in SMARTCOP-NLR and the lowest AUC of 0.804 (95% CI 0.752-0.855) in CRB65-NLR.
CONCLUSIONS
There was a non-linear association between NLR and 30-day mortality in older patients with CAP. The addition of NLR to the conventional scoring systems significantly increased their discrimination.
目的
我们旨在评估老年社区获得性肺炎（CAP）住院患者的中性粒细胞与淋巴细胞比值（NLR）与不良结局之间是否存在线性关系。还研究了将NLR添加到当前肺炎严重程度评分（包括CURB-65、CRB-65、A-DROP和SMART-COP）中预测30天死亡率的性能。
方法
这是一项基于现有老年CAP队列数据集的二次分析，包括812例患者。入院时的临床和实验室结果用于计算上述评分。主要结局是30天死亡率。根据NLR四分位数对基线特征和结局进行分组呈现。采用多变量调整逻辑回归和受限立方样条来评估NLR与30天死亡率之间的关联。在上述四个评分系统中添加NLR后开发更新的系统。通过受试者操作特征曲线下面积（AUC）评估模型辨别力。
结果
与最低四分位数NLR组相比，较高四分位数NLR组的30天死亡风险增加，最高四分位数组的死亡率为18.3%（37/202）。发现NLR与30天死亡率存在显著关联，比值比为1.017（95%置信区间[CI]1.002 - 1.032），但在调整年龄、性别和合并症后不再显著。观察到NLR与30天死亡率呈非线性正相关，死亡率随NLR升高至16时加速上升。预测30天死亡率的NLR最佳截断值为6.5，用于通过添加NLR更新评分系统。四个系统更新后的AUC均显著改善（均p < 0.05），SMART-COP-NLR的AUC最高，为0.847（95%CI 0.804 - 0.891），CRB65-NLR的AUC最低，为0.804（95%CI 0.752 - 0.855）。
结论
老年CAP患者中，NLR与30天死亡率之间存在非线性关联。将NLR添加到传统评分系统中可显著提高其辨别力。
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