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

Abstract

Community-acquired pneumonia (CAP) is common among the elderly; it typically has a poor prognosis and high mortality. This study evaluated the factors predicting CAPrelated 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 inhospital 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 inhospital mortality in the elderly.

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

“…It is characterized by high rates of mortality and morbidity, especially in elderly patients. NLR has demonstrated a strong predictive value concerning short- and long-term mortality, need for ICU admission and re-hospitalization [ 24 , 25 , 26 , 27 , 28 ]. Therefore, NLR correlated with post-CAP mortality better than traditional pneumonia scores (Pneumonia Severity Index, PSI; and Confusion, Urea, Respiratory rate and Blood pressure, aged 65 and older, CURB-65), WBC and CRP [ 24 ].…”

Association between neutrophil to lymphocyte ratio and mortality among community acquired pneumonia patients: a meta-analysis

“…The remaining 27 studies were further scrutinized by reading the full text. Finally, only 10 studies were included in this meta-analysis [18][19][20][21][25][26][27][28][29][30]. 6 reported the predictive AUC value on 30-Day Mortality [19,21,[25][26][27][28] (of which 4 studies reported admission NLR levels, one study reported NLR at 3-5 days and 1 study reported both), 4 reported the mean NLR Values of survivors and 30-day non-survivor groups [19,20,25,26] (of which two reported admission NLR levels and two have reported both admission and 3-5 days NLR), and 3 reported the mean NLR Values of survivors and In-Hospital non-survivors groups [18,29,30] (All of which only reported admission NLR levels).…”

“…Three studies have evaluated the mean+-SD NLR admission values in the survivors and In-Hospital non-survivors [18,29,30]. Meta-analysis of these studies showed a significant difference in the NLR between the survivors and in-hospital non-survivors (SMD = 1.053, 95% confidence interval (CI) = 0.813 to 1.294, P = <0.001) (Figure 3).…”

“…Meta-analysis of these studies showed a significant difference in the NLR between the survivors and in-hospital non-survivors (SMD = 1.053, 95% confidence interval (CI) = 0.813 to 1.294, P = <0.001) (Figure 3). Only one study was found to evaluate the predictive capacity of NLR and in-hospital mortality of CAP patients, accompanied with enough information to enable calculation of the standard error [29]. This has restricted us from reaching a pooled AUC value.…”

C-reactive protein to albumin ratio is associated with increased risk of mortality in COVID-19 pneumonia patients

“…Despite the fact that significant advances in global health have taken place, pneumonia is one of the most common infectious diseases requiring hospitalization and is associated with high morbidity and mortality 1,2 . SARS-CoV-2 (COVID-19), the 7 th CoV known after SARS-, CoV and MERS-CoV, is the pathogen of the ongoing new pneumonia epidemic that infects humans 3 .…”