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[Predictive value of neutrophil to lymphocyte ratio on 28-day mortality of patients with severe pneumonia].
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Jul; 31(7):827-831.ZW

Abstract

OBJECTIVE

To evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) on 28-day mortality of patients with severe pneumonia.

METHODS

The clinical data of 214 severe pneumonia patients admitted to the department of emergency medicine of the First Affiliated Hospital of Xi'an Jiao Tong University from January 2015 to December 2018 were retrospectively analyzed. The clinical parameters, such as gender, age, underlying diseases, and blood routine, procalcitonin (PCT), liver and kidney function, blood lactic acid (Lac), arterial partial pressure of oxygen (PaO2) at admission or within 24 hours after admission were reviewed. NLR, oxygenation index (PaO2/FiO2) and acute physiology and chronic health evaluation II (APACHE II) were calculated, and the change tendency of each index within 3 days after admission were observed. The patients were divided into survival group and death group according to 28-day outcomes. Multivariate Logistic regression analysis was used to screen the high risk factors of 28-day mortality in patients with severe pneumonia. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of NLR for 28-day mortality risk in patients with severe pneumonia.

RESULTS

214 patients were enrolled in the analysis, 132 survived in 28 days and 82 died. Compared with survival group, the white blood cell (WBC), neutrophil (NEU), NLR, PCT, Lac and APACHE II scores were significantly increased, and lymphocyte (LYM) was significantly decreased in the death group. There was no significant difference in gender, age, basic diseases, platelet count (PLT), liver and kidney function parameters, or PaO2/FiO2 between the two groups. The NLR, PCT, Lac and APACHE II score in the death group were increased gradually within 3 days after admission, PaO2/FiO2 was decreased gradually, which showed significant differences as compared with survival group at 3 days after admission [NLR: 27.15±7.61 vs. 14.66±4.83, PCT (μg/L): 13.52±3.22 vs. 6.41±4.22, Lac (mmol/L): 6.78±1.70 vs. 2.74±1.15, APACHE II score: 37.76±5.30 vs. 22.11±4.94, PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 114.12±20.16 vs. 186.49±13.95, all P < 0.05]. Multiple Logistic regression analysis showed that NLR [odds ratio (OR) = 1.163, 95% confidence interval (95%CI) = 1.007-1.343, P = 0.040], PCT (OR = 1.210, 95%CI = 1.098-1.333, P = 0.001), Lac (OR = 1.263, 95%CI = 1.011-1.579, P = 0.040) and APACHE II score (OR = 1.103, 95%CI = 1.032-1.179, P = 0.004) were the independent risk factors of 28-day mortality in the patients with severe pneumonia. ROC curve analysis showed that compared with the traditional indicators including PCT, Lac, and APACHE II score, NLR showed a good predictive value for 28-day mortality in the patients with severe pneumonia [area under ROC curve (AUC): 0.791 vs. 0.707, 0.690, 0.720]. When the optimal cut-off value of NLR was 14.92, the sensitivity was 71.95% and the specificity was 73.48%, meanwhile, the positive likelihood ratio was 2.713 and the negative likelihood ratio was 0.382.

CONCLUSIONS

The increased NLR at admission is a high risk factor of 28-day mortality in patients with severe pneumonia, which is useful for predicting prognosis of patients with severe pneumonia.

Authors+Show Affiliations

Department of Emergency Medical, the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, Shaanxi, China.Department of Emergency Medical, the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, Shaanxi, China.Department of Emergency Medical, the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, Shaanxi, China.Department of Emergency Medical, the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, Shaanxi, China.Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu, China. Corresponding author: He Fei, Email: hefei1201@163.com.

Pub Type(s)

Journal Article

Language

chi

PubMed ID

31441404

Citation

Liang, Huan, et al. "[Predictive Value of Neutrophil to Lymphocyte Ratio On 28-day Mortality of Patients With Severe Pneumonia]." Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, vol. 31, no. 7, 2019, pp. 827-831.
Liang H, Gao Y, Miao C, et al. [Predictive value of neutrophil to lymphocyte ratio on 28-day mortality of patients with severe pneumonia]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019;31(7):827-831.
Liang, H., Gao, Y., Miao, C., Song, Y., & He, F. (2019). [Predictive value of neutrophil to lymphocyte ratio on 28-day mortality of patients with severe pneumonia]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 31(7), 827-831. https://doi.org/10.3760/cma.j.issn.2095-4352.2019.07.006
Liang H, et al. [Predictive Value of Neutrophil to Lymphocyte Ratio On 28-day Mortality of Patients With Severe Pneumonia]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019;31(7):827-831. PubMed PMID: 31441404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Predictive value of neutrophil to lymphocyte ratio on 28-day mortality of patients with severe pneumonia]. AU - Liang,Huan, AU - Gao,Ye, AU - Miao,Changqing, AU - Song,Yinxue, AU - He,Fei, PY - 2019/8/24/entrez PY - 2019/8/24/pubmed PY - 2019/10/18/medline SP - 827 EP - 831 JF - Zhonghua wei zhong bing ji jiu yi xue JO - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue VL - 31 IS - 7 N2 - OBJECTIVE: To evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) on 28-day mortality of patients with severe pneumonia. METHODS: The clinical data of 214 severe pneumonia patients admitted to the department of emergency medicine of the First Affiliated Hospital of Xi'an Jiao Tong University from January 2015 to December 2018 were retrospectively analyzed. The clinical parameters, such as gender, age, underlying diseases, and blood routine, procalcitonin (PCT), liver and kidney function, blood lactic acid (Lac), arterial partial pressure of oxygen (PaO2) at admission or within 24 hours after admission were reviewed. NLR, oxygenation index (PaO2/FiO2) and acute physiology and chronic health evaluation II (APACHE II) were calculated, and the change tendency of each index within 3 days after admission were observed. The patients were divided into survival group and death group according to 28-day outcomes. Multivariate Logistic regression analysis was used to screen the high risk factors of 28-day mortality in patients with severe pneumonia. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of NLR for 28-day mortality risk in patients with severe pneumonia. RESULTS: 214 patients were enrolled in the analysis, 132 survived in 28 days and 82 died. Compared with survival group, the white blood cell (WBC), neutrophil (NEU), NLR, PCT, Lac and APACHE II scores were significantly increased, and lymphocyte (LYM) was significantly decreased in the death group. There was no significant difference in gender, age, basic diseases, platelet count (PLT), liver and kidney function parameters, or PaO2/FiO2 between the two groups. The NLR, PCT, Lac and APACHE II score in the death group were increased gradually within 3 days after admission, PaO2/FiO2 was decreased gradually, which showed significant differences as compared with survival group at 3 days after admission [NLR: 27.15±7.61 vs. 14.66±4.83, PCT (μg/L): 13.52±3.22 vs. 6.41±4.22, Lac (mmol/L): 6.78±1.70 vs. 2.74±1.15, APACHE II score: 37.76±5.30 vs. 22.11±4.94, PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 114.12±20.16 vs. 186.49±13.95, all P < 0.05]. Multiple Logistic regression analysis showed that NLR [odds ratio (OR) = 1.163, 95% confidence interval (95%CI) = 1.007-1.343, P = 0.040], PCT (OR = 1.210, 95%CI = 1.098-1.333, P = 0.001), Lac (OR = 1.263, 95%CI = 1.011-1.579, P = 0.040) and APACHE II score (OR = 1.103, 95%CI = 1.032-1.179, P = 0.004) were the independent risk factors of 28-day mortality in the patients with severe pneumonia. ROC curve analysis showed that compared with the traditional indicators including PCT, Lac, and APACHE II score, NLR showed a good predictive value for 28-day mortality in the patients with severe pneumonia [area under ROC curve (AUC): 0.791 vs. 0.707, 0.690, 0.720]. When the optimal cut-off value of NLR was 14.92, the sensitivity was 71.95% and the specificity was 73.48%, meanwhile, the positive likelihood ratio was 2.713 and the negative likelihood ratio was 0.382. CONCLUSIONS: The increased NLR at admission is a high risk factor of 28-day mortality in patients with severe pneumonia, which is useful for predicting prognosis of patients with severe pneumonia. SN - 2095-4352 UR - https://www.unboundmedicine.com/medline/citation/31441404/[Predictive_value_of_neutrophil_to_lymphocyte_ratio_on_28_day_mortality_of_patients_with_severe_pneumonia]_ L2 - https://medlineplus.gov/pneumonia.html DB - PRIME DP - Unbound Medicine ER -