Combined Neutrophil-to-Lymphocyte Ratio and CURB-65 Score As an Accurate Predictor of Mortality for Community-Acquired Pneumonia in the Elderly

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2021 Apr 9

PMID 33833552

Citations 3

Authors

Ding-Yun Feng

Xiao-Ling Zou

Yu-Qi Zhou

Wen-Bin Wu

Hai-Ling Yang

Tian-Tuo Zhang

Affiliations

Soon will be listed here.

Abstract

Purpose: Community-acquired pneumonia (CAP) is common among the elderly; it typically has a poor prognosis and high mortality. This study evaluated the factors predicting CAP-related in-hospital mortality in the elderly to identify a simpler and more accurate predictor.

Patients And Methods: This was a single-center, retrospective study. The data used in this study was collected from all older patients (≥65) with CAP admitted to our hospital between January 2012 and April 2020.

Results: A total of 2028 older patients with CAP were included; 121 (5.97%) died in hospital. Of the patients in the study, 1267 (62.5%) were men and 261 (12.9%) had a history of malignant tumors. After performing univariate and multivariate Cox regression analyses, sex, history of malignant tumor, CURB-65 score, neutrophil-to-lymphocyte ratio (NLR), hemoglobin level, and NLR*CURB-65 levels were associated with CAP mortality. By comparing the area under the receiver operating characteristic (ROC) curves of the predicted factors, the NLR*CURB-65 level used to predict CAP mortality in the elderly was 0.755, and was superior to other measurements. All included patients were then dichotomized into two groups based on NLR*CURB-65 level (≤9.06 and >9.06) according to the ROC analysis. Patients with a high NLR*CURB-65 level had higher in-hospital mortality than those with a low NLR*CURB-65 level. The two divided groups showed significant differences in age, sex, smoking history, comorbidity, and laboratory findings. This indicates that NLR*CURB-65 is a predictive index that could reflect the comprehensive condition of older patients with CAP.

Conclusion: NLR*CURB-65 is a simpler and more accurate predictor of CAP-related in-hospital mortality in the elderly.

Citing Articles

Establishment of risk model for elderly CAP at different age stages: a single-center retrospective observational study.

Lv C, Pan T, Shi W, Peng W, Gao Y, Muhith A Sci Rep. 2023; 13(1):12432.

PMID: 37528213 PMC: 10393957. DOI: 10.1038/s41598-023-39542-3.

Prognostic Factors for Cardiovascular Events in Elderly Patients with Community Acquired Pneumonia: Results from the CAP-China Network.

Han X, Chen L, Li H, Zhou F, Xing X, Zhang C Clin Interv Aging. 2022; 17:603-614.

PMID: 35497052 PMC: 9047947. DOI: 10.2147/CIA.S356925.

Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases.

Buonacera A, Stancanelli B, Colaci M, Malatino L Int J Mol Sci. 2022; 23(7).

PMID: 35408994 PMC: 8998851. DOI: 10.3390/ijms23073636.

References

Kartal O, Kartal A . Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy. 2017; 118(9):513-516. DOI: 10.4149/BLL_2017_099. View

Schuetz P, Koller M, Christ-Crain M, Steyerberg E, Stolz D, Muller C . Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings. Epidemiol Infect. 2008; 136(12):1628-37. PMC: 2870789. DOI: 10.1017/S0950268808000435. View

Mandell L, Wunderink R, Anzueto A, Bartlett J, Campbell G, Dean N . Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. PMC: 7107997. DOI: 10.1086/511159. View

Lim W, van der Eerden M, Laing R, Boersma W, Karalus N, Town G . Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003; 58(5):377-82. PMC: 1746657. DOI: 10.1136/thorax.58.5.377. View

Chong C, Street P . Pneumonia in the elderly: a review of severity assessment, prognosis, mortality, prevention, and treatment. South Med J. 2008; 101(11):1134-40. DOI: 10.1097/SMJ.0b013e31818247f1. View

Zhang H, Ge Y, Wang H, Zhang Q, Li W, Chen Y . Neutrophil-to-Lymphocyte Ratio Improves the Accuracy and Sensitivity of Pneumonia Severity Index in Predicting 30-Day Mortality of CAP Patients. Clin Lab. 2019; 65(10). DOI: 10.7754/Clin.Lab.2019.190226. View

Watts N, Amann M, Ayeb-Karlsson S, Belesova K, Bouley T, Boykoff M . The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet. 2017; 391(10120):581-630. DOI: 10.1016/S0140-6736(17)32464-9. View

Toledo D, Soldevila N, Torner N, Perez-Lozano M, Espejo E, Navarro G . Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: a cross-sectional study in seven Spanish regions. BMJ Open. 2018; 8(3):e020243. PMC: 5884368. DOI: 10.1136/bmjopen-2017-020243. View

Han X, Zhou F, Li H, Xing X, Chen L, Wang Y . Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia. BMC Infect Dis. 2018; 18(1):192. PMC: 5922029. DOI: 10.1186/s12879-018-3098-5. View

10.

Huang Y, Liu A, Liang L, Jiang J, Luo H, Deng W . Diagnostic value of blood parameters for community-acquired pneumonia. Int Immunopharmacol. 2018; 64:10-15. DOI: 10.1016/j.intimp.2018.08.022. View

11.

Wang Y, Zhang S, Li L, Xie J . The usefulness of serum procalcitonin, C-reactive protein, soluble triggering receptor expressed on myeloid cells 1 and Clinical Pulmonary Infection Score for evaluation of severity and prognosis of community-acquired pneumonia in elderly patients. Arch Gerontol Geriatr. 2018; 80:53-57. DOI: 10.1016/j.archger.2018.10.005. View

12.

Miyashita N, Yamauchi Y . Bacterial Pneumonia in Elderly Japanese Populations. Jpn Clin Med. 2018; 9:1179670717751433. PMC: 5804998. DOI: 10.1177/1179670717751433. View

13.

Reade M, Weissfeld L, Angus D, Kellum J, Milbrandt E . The prevalence of anemia and its association with 90-day mortality in hospitalized community-acquired pneumonia. BMC Pulm Med. 2010; 10:15. PMC: 2848211. DOI: 10.1186/1471-2466-10-15. View

14.

Arias-Fernandez L, Gil-Prieto R, Gil-de-Miguel A . Incidence, mortality, and lethality of hospitalizations for community-acquired pneumonia with comorbid cardiovascular disease in Spain (1997-2015). BMC Infect Dis. 2020; 20(1):477. PMC: 7336298. DOI: 10.1186/s12879-020-05208-y. View

15.

. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1736-1788. PMC: 6227606. DOI: 10.1016/S0140-6736(18)32203-7. View

16.

Fink M . Pathophysiology of intensive care unit-acquired anemia. Crit Care. 2004; 8 Suppl 2:S9-10. PMC: 3226145. DOI: 10.1186/cc2410. View

17.

Komiya K, Rubin B, Kadota J, Mukae H, Akaba T, Moro H . Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis. Sci Rep. 2016; 6:38097. PMC: 5141412. DOI: 10.1038/srep38097. View

18.

Pessoa E, Barbara C, Viegas L, Costa A, Rosa M, Nogueira P . Factors associated with in-hospital mortality from community-acquired pneumonia in Portugal: 2000-2014. BMC Pulm Med. 2020; 20(1):18. PMC: 6974967. DOI: 10.1186/s12890-019-1045-x. View

19.

Sacks D, Baxter B, Campbell B, Carpenter J, Cognard C, Dippel D . Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. Int J Stroke. 2018; 13(6):612-632. DOI: 10.1177/1747493018778713. View

20.

Aston S, Ho A, Jary H, Huwa J, Mitchell T, Ibitoye S . Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi. Am J Respir Crit Care Med. 2019; 200(3):359-369. PMC: 6680311. DOI: 10.1164/rccm.201807-1333OC. View