Resumen de Neutrophil-To-Lymphocyte Ratio: An Emerging Marker Predicting Prognosis in Elderly Adults with Community-Acquired Pneumonia

Emanuela Cataudella, Chiara M. Giraffa, Salvatore Di Marca, Alfredo Pulvirenti, Salvatore Alaimo, Marcella Pisano, Valentina Terranova, Thea Corriere, Maria L. Ronsisvalle, Rosario Di Quattro, Benedetta Stancanelli, Mauro Giordano, Carlo Vancheri , Lorenzo Malatino

• Objectives To explore the performance of the neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation that predicts prognosis of several diseases, in a cohort of elderly adults with community-acquired pneumonia (CAP).

  Design Prospective clinical study from January 2014 to July 2016.

  Setting Unit of Internal Medicine, University of Catania, Catania, Italy.

  Participants Elderly adults admitted for CAP (N = 195).

  Measurements Clinical diagnosis of CAP was defined as the presence of a new infiltrate on plain chest radiography or chest computed tomography associated with one or more suggestive clinical features such as dyspnea, hypo- or hyperthermia, cough, sputum production, tachypnea (respiration rate >20 breaths per minute), altered breath sounds on physical examination, hypoxemia (partial pressure of oxygen <60 mmHg), leukocytosis (white blood cell count >10,000/μL). Clinical examination, traditional tests such as Pneumonia Severity Index (PSI); Confusion, Urea, Respiratory rate, Blood pressure, aged 65 and older (CURB-65), and NLR were evaluated at admission. The accuracy and predictive value for 30-day mortality of traditional scores and NLR were compared.

  Results NLR predicted 30-day mortality (P < .001) and performed better than PSI (P < .05), CURB-65, C-reactive protein, and white blood cell count (P < .001) to predict prognosis. No deaths occurred in participants with a NLR of less than 11.12. Thirty-day mortality was 30% in those with a NLR between 11.12% and 13.4% and 50% in those with a NLR between 13.4 and 28.3. All participants with a NLR greater than 28.3 died within 30 days.

  Conclusions These results would encourage early discharge of individuals with a NLR of less than 11.12, short-term in-hospital care for those with a NLR between 11.12 and 13.4, middle-term hospitalization for those with a NLR between 13.4 and 28.3, and admission to a respiratory intensive care unit for those with a NLR greater than 28.3.