Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia

• Published in: PloS one Vol. 16; no. 4; p. e0250067
• Main Authors: Lee, Heock, Kim, Insu, Kang, Bo Hyoung, Um, Soo-Jung
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.04.2021; Public Library of Science (PLoS)
• Subjects: Antibiotics; Bacterial pneumonia; Biology and Life Sciences; Biomarkers; C-reactive protein; Chemotherapy; Chest; Clinical outcomes; Cough; Cytokines; Developed countries; Edema; Editing; Embolism; Fever; Genetic aspects; Hemoptysis; Hospitalization; Immunoassay; Infectious diseases; Inflammation; Interferon; Interleukin 6; Interleukin 8; Internal medicine; Leukocytes; Leukocytes (neutrophilic); Lung cancer; Lung diseases; Lymphocytes; Medical prognosis; Medical schools; Medicine; Medicine and Health Sciences; Morbidity; Mortality; Neutrophils; Pain; Physiological aspects; Pneumonia; Procalcitonin; Prognosis; Public health; Pulmonology; Radiation therapy; Radiographs; Regression analysis; Signs and symptoms; Sputum; Staphylococcus infections; Steroids; Thorax; Tuberculosis; Variables; α-Interferon; South Korea; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0250067

Several serum inflammatory markers are associated with poor clinical outcomes in community-acquired pneumonia (CAP). However, the prognosis and early treatment response in hospitalized CAP patients based on serial neutrophil-to-lymphocyte ratio (NLR) measurement has never been investigated. We performed a retrospective observational study for 175 consecutive patients hospitalized with CAP between February 2016 and February 2018. NLR, C-reactive protein (CRP) and procalcitonin levels were measured on admission day (D1) and on hospital day 4 (D4). The Pneumonia Severity Index (PSI) was also assessed on admission. The primary endpoint was all-cause death within 30 days after admission. The secondary endpoint was early treatment response such as intensive care unit (ICU) admission during hospitalization and clinical unstability on day 4. The 30-day mortality rate was 9.7%. In multivariate analysis, NLR D4 (OR: 1.11; 95% CI: 1.04-1.18; P = 0.003) and its incremental change (NLR D4/D1 >1) (OR: 7.10; 95% CI: 2.19-23.06; P = 0.001) were significant predictors of 30-day mortality. NLR D4 and its incremental change were significant predictors of ICU admission and clinical unstability on day 4 in multivariate analyses. Adding of incremental NLR change significantly improved the prognostic ability of the PSI. The additive value of incremental NLR change for the prognostic ability of the PSI was larger than that of incremental CRP change. Serial NLR measurement represents useful laboratory tool to predict the prognosis and early treatment response of hospitalized CAP patients.