Procalcitonin and C-reactive protein perform better than the neutrophil/lymphocyte count ratio in evaluating hospital acquired pneumonia

Zheng, Nan; Zhu, Dongmei; Han, Yi

doi:10.1186/s12890-020-01207-6

Cited by 21 publications

(23 citation statements)

References 34 publications

(43 reference statements)

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“…Most of the above-mentioned studies showed these associations to be of prognostic value as well [ 21 , 23 - 24 ]. Zheng et al, however, reported CRP and procalcitonin to be better biomarkers than NLR for predicting sepsis [ 25 ]. Besides, the combination of NLR and CRP improved the diagnosis of early sepsis in study participants.…”

Section: Discussionmentioning

confidence: 99%

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Rehman¹,

Khan²,

Aziz³

et al. 2020

Cureus

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Background Neutrophil to lymphocyte ratio (NLR) can be easily calculated from the white cell differential count and is considered an auspicious marker for predicting different diseases, including sepsis. In this study, we aimed to compare the efficacy of NLR as a sepsis marker by comparing it with other markers of sepsis, such as Creactive protein (CRP), procalcitonin, and the Sequential Organ Failure Assessment (SOFA) score. Methods A cross-sectional analytical study was conducted at the Aga Khan University Hospital from July 2019 to December 2019. A total of 168 patients who were admitted to the medicine department with a diagnosis of sepsis on arrival or during the hospital stay were enrolled. The neutrophil to lymphocyte ratio was calculated to form venous samples taken on admission and compared to the level of CRP, procalcitonin, culture reports, and the SOFA score as a predictor of sepsis. Results Out of 168 patients, 55.3% were male. The median age of the participants was 68.40 (interquartile range (IQR): 19.5) years in males and 64.0 (IQR: 18.0) in females. Procalcitonin was performed in 121 (72%) and CRP performed in 61 (36.3%) patients. The NLR showed significant associations with all the tested lab parameters of sepsis, such as CRP (p = 0.02), procalcitonin (p = 0.01), and SOFA score (p = 0.01). Values when analyzed according to culture-positive showed higher values in culture-positive samples but were not statistically significant. Conclusion Neutrophil to lymphocyte ratio is a cheap and rapidly available predictor of sepsis and has shown a significant correlation with other relatively expensive and non-rapidly existing markers of inflammation and sepsis. However, large prospective studies are needed to prove its real effectiveness as a marker of sepsis and its prognosis

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Section: Discussionmentioning

confidence: 99%

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Rehman¹,

Khan²,

Aziz³

et al. 2020

Cureus

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“…Another study has demonstrated that the NLR improves the accuracy and sensitivity of PSI to predict 30-day mortality in adult CAP patients [ 15 ]. In contrast, the NLR was not comparable to CRP and PCT for diagnosing or evaluating the severity of pneumonia in recently published study [ 22 ]. However, this study evaluated patients with hospital acquired pneumonia and analyzed the levels of NLR, CRP and PCT once measured on admission to the ICU.…”

Section: Discussionmentioning

confidence: 85%

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

et al. 2021

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Introduction 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. Methods 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. Results 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. Conclusion Serial NLR measurement represents useful laboratory tool to predict the prognosis and early treatment response of hospitalized CAP patients.

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“…Elevated PCT levels and other inflammatory mediators were detected in non-survivors, proving that inflammatory markers predict mortality in critically ill patients. Nonetheless, serum lactate levels and neutrophil count did not project striking differences in both groups [11]. In another study regulated between the middle-aged and elderly population, urinary tract infections and respiratory infections were prominent causes of sepsis.…”

Section: Discussionmentioning

confidence: 90%

“…In numerous studies, levels of PCT, C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and total leukocyte count (TLC) were significantly elevated in patients with positive bacterial growth cultures compared to negative cultures [4,8,11]. Escherichia coli and Staphylococcus aureus were prominently isolated organisms within cultures reported by various studies [4,8].…”

Section: Discussionmentioning

confidence: 98%

“…In recent years, multiple studies have been regulated in detecting the role of inflammatory mediators in diagnosing sepsis in severely ill trauma patients. In miscellaneous studies, the mean age of significantly ill traumatic patients suffering from sepsis ranged from 40 to 71 years, making it prevalent in the middle-aged and elderly population [4,8,10,11]. Sepsis in sufferers of trauma displayed genetic affinity towards males compared to females [8,10,11].…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of Procalcitonin Levels for Diagnosis of Culture-Positive Sepsis in Critically Ill Trauma Patients: A Retrospective Analysis

Bakhtiar¹,

Kazmi²,

Asghar³

et al. 2021

Cureus

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Background Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. Procalcitonin levels (PCT) have recently emerged as a promising biomarker in the diagnosis of sepsis. The aim of the present study is to determine the diagnostic accuracy of PCT levels in predicting sepsis in critically ill trauma patients. Methodology This was designed as a validation study conducted in the Indoor Department of General Surgery, Liaquat National Hospital, Karachi. The sample size was calculated by taking the estimated frequency of sepsis in suspected patients at 62.13%, expected sensitivity of PCT at 70.83%, and specificity at 84.21% and the desired precision level of 12% for sensitivity; the calculated sample size was 96. The non-probability consecutive sampling method was used to recruit participants who were diagnosed with sepsis on clinical assessment. Blood culture samples were sent for the enrolled patients and a final diagnosis was made on the blood culture report. PCT levels were measured in these suspected patients on the same day of sending blood culture. Diagnostic accuracy of PCT size was measured using the receiver operating characteristic (ROC) curve. ROC curve was formulated for PCT levels against culture-proven sepsis to determine the ideal cut-off value of PCT levels. Two different cut-offs were determined to obtain the highest sensitivity and highest specificity accordingly. Results A total of 97 individuals met the inclusion criteria with a mean age of 34.89 ± 10.52 years. Mean PCT levels were 0.96 ± 0.59, with a gender predilection towards females (p < 0.001). No age difference was documented among gender (p = 0.655). The mean duration of intensive care unit stay was 11.73 ± 3.56 days. Culture-proven sepsis was identified in 67.0% of the study participants with a higher PCT level (p < 0.001). Among the 52.6% males included in the study, half were reported to have culture-positive sepsis, but among the 47.4% females culture was positive in 87% (p < 0.001). ROC revealed PCT was predictive for culture-positive sepsis at a cut-off value 0.47 ng/mL (p < 0.001), with a sensitivity of 92.3%, specificity of 68.7%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 81.5%. By increasing the cut-off value to 0.90 ng/mL at area under the curve of 0.816, the specificity increased to 81.3% and sensitivity became 66.2%, ...

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Procalcitonin and C-reactive protein perform better than the neutrophil/lymphocyte count ratio in evaluating hospital acquired pneumonia

Cited by 21 publications

References 34 publications

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis

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

Accuracy of Procalcitonin Levels for Diagnosis of Culture-Positive Sepsis in Critically Ill Trauma Patients: A Retrospective Analysis

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