Is the neutrophil/lymphocyte rate as effective as CURB-65 in the patient management of the community-acquired pneumonia patients admitted to the Emergency Medicine?

Yıl 2021, Cilt: 7 Sayı: 2, 184 - 191, 04.03.2021

İlker Barut , Melih Yüksel , Halil Kaya , Zülfi Engindeniz

https://doi.org/10.18621/eurj.678454

Öz

Objectives: The aim of this study was to identify the patients with community-acquired pneumonia (CAP) in emergency departments, and to compare CURB-65 scoring system and Neutrophil/Lymphocyte Ratio (NLO) which are some of the commonly used blood parameters to make an inpatient or outpatient decision quickly and effectively.

Methods: This study was performed retrospectively by examining the files of 442 patients who were admitted to the adult emergency department of Bursa Yüksek İhtisas Training and Research Hospital between September 1, 2017 and October 31, 2018. The demographic characteristics, physical examination findings, laboratory results, hospitalizations, and CURB-65 scores of the patients included in the study were recorded on a pre-prepared paper and electronic form and statistical analyzes of these data were conducted.

Results: Two hundred and fifty-five (57.69%) patients were male and the mean age was 70.93 years. The mean NLO value was 9.85, the mean MPV value was 8.62, the mean eosinophil value was 0.15 and the mean CURB-65 score was 1.85. When the post hoc paired group comparison was conducted for the mean NLR, it was found that the other groups differed from each other except the groups admitted to the intensive care unit and the service. Glasgow Coma Scale score and CURB-65 score were found to be significant predictors for hospitalization to service and intensive care unit (p < 0.05).

Conclusions: We think that NLR may be useful in decision-making process, especially in prospective studies, although the use of NLR in patients with CAP is not statistically significant. In this study, we also examined that CURB-65 is an effective scoring system in the management of this patient group. 

Anahtar Kelimeler

Emergency department, community-acquired pneumonia, CURB-65, neutrophil/lymphocyte ratio

Kaynakça

• 1. Lanks CW, Musani AI, Hsia DW. Community-acquired pneumonia and hospital-acquired pneumonia. Med Clin North Am 2019;103:487-501.
• 2. The 10 leading causes of death in the world: World Health Organization 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
• 3. Rider AC, Frazee BW. Community-acquired pneumonia. Emerg Med Clin North Am 2018;36:665-83.
• 4. Musher DM, Thorner AR. Community-acquired pneumonia. N Eng J Med 2014;371:1619-28.
• 5. Janssens JP, Krause KH. Pneumonia in the very old. Lancet Infect Dis 2004;4:112-24.
• 6. Bellelli G, Guerini F, Cerri AP, Trabucchi M. A sudden decline in mobility status as an early sign of acute infection in elderly patients: evidence from three case reports. Aging Clin Exp Res 2012;24:281-4.
• 7. Khokhar SR, Stern Y, Bell K, Anderson K, Noe E, Mayeux R, et al. Persistent mobility deficit in the absence of deficits in activities of daily living: a risk factor for mortality. J Am Geriatr Soc 2001;49:1539-43.
• 8. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-82.
• 9. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Eng J Med 1997;336:243-50.
• 10. Li J, Chen Q, Luo X, Hong J, Pan K, Lin X, et al. Neutrophil‐to‐lymphocyte ratio positively correlates to age in healthy population. J Clin Lab Anal 2015;29:437-43.
• 11. Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017;35:234-9.
• 12. Jia D, Liu F, Zhang Q, Zeng GQ, Li XL, Hou G. Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room. J Clin Lab Anal 2018;32:e22362.
• 13. Wang X, Zhang G, Jiang X, Zhu H, Lu Z, Xu L. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: a meta-analysis of observational studies. Atherosclerosis. 2014;234:206-13.
• 14. Gokhan S, Ozhasenekler A, Mansur Durgun H, Akil E, Ustundag M, Orak M. Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack. Eur Rev Med Pharmacol Sci 2013;17:653-7.
• 15. Pinner RW, Teutsch SM, Simonsen L, Klug LA, Graber JM, Clarke MJ, et al. Trends in infectious diseases mortality in the United States. JAMA 1996;275:189-93.
• 16. Acute respiratory infections in under-fives: 15 million deaths a year. Lancet (London, England). 1985;2:699-701.
• 17. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax 2001;56 Suppl 4:Iv1-64.
• 18. Jokinen C, Heiskanen L, Juvonen H, Kallinen S, Karkola K, Korppi M, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993;137:977-88.
• 19. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Eng J Med 2015;373:415-27.
• 20. Başkent Üniversitesi Ulusal Hastalık Yükü ve Maliyeti Etkinlik Projesi.TC Sağlık Bakanlığı Sağlık İstatistikleri Yıllığı.Refik Saydam Hıfzıssıhha Merkezi Başkanlığı Hıfzıssıhha Mektebi Müdürlüğü.2004.
• 21. Breitling LP, Saum KU, Schottker B, Holleczek B, Herth FJ, Brenner H. Pneumonia in the noninstitutionalized older population. Dtsch Arztebl Int 2016;113:607-14.
• 22. Kolditz M, Tesch F, Mocke L, Hoffken G, Ewig S, Schmitt J. Burden and risk factors of ambulatory or hospitalized CAP: A population based cohort study. Respir Med 2016;121:32-8.
• 23. Kolditz M, Ewig S. Community-acquired pneumonia in adults. Dtsch Arztebl Int 2017;114:838.
• 24. Dirmesropian S, Liu B, Wood JG, MacIntyre CR, McIntyre P, Karki S, et al. Pneumonia hospitalisation and case-fatality rates in older Australians with and without risk factors for pneumococcal disease: implications for vaccine policy. Epidemiol Infect 2019;147:e118.
• 25. Guest JF, Morris A. Community-acquired pneumonia: the annual cost to the National Health Service in the UK. Eur Respir J 1997;10:1530-4.
• 26. Cataudella E, Giraffa CM, Di Marca S, Pulvirenti A, Alaimo S, Pisano M, et al. Neutrophil-to-lymphocyte ratio: an emerging marker predicting prognosis in elderly adults with community-acquired pneumonia. J Am Geriatr Soc 2017;65:1796-801.
• 27. Rozenbaum MH, Mangen MJ, Huijts SM, van der Werf TS, Postma MJ. Incidence, direct costs and duration of hospitalization of patients hospitalized with community acquired pneumonia: a nationwide retrospective claims database analysis. Vaccine 2015;33:3193-9.
• 28. Marrie T, Lau C, Wheeler S, Wong C, Vandervoort M, Feagan B, et al. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA 2000;283:749-55.
• 29. Karakonstantis S, Kalemaki D, Tzagkarakis E, Lydakis C. Pitfalls in studies of eosinopenia and neutrophil-to-lymphocyte count ratio. Infect Dis 2018;50:163-74.
• 30. Rodriguez-Fernandez A, Andaluz-Ojeda D, Almansa R, Justel M, Eiros JM, Ortiz de Lejarazu R. Eosinophil as a protective cell in S. aureus ventilator-associated pneumonia. Mediators Inflamm 2013;2013:152943.
• 31. Aydın İ, Ağıllı M, Aydın FN, Kurt YG, Çaycı T, Taş A, et al. [The reference ranges of neutrophil-lymphocyte ratio in different age groups]. Gülhane Tıp Derg 2015;57:414-8. [Article in Turkish]
• 32. De Jager CP, Wever PC, Gemen EF, Kusters R, van Gageldonk-Lafeber AB, van der Poll T, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PloS One 2012;7:e46561.
• 33. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5-14.
• 34. Ljungstrom L, Pernestig AK, Jacobsson G, Andersson R, Usener B, Tilevik D. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PloS One 2017;12:e0181704.