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

Autor:	Cataudella, Emanuela, Giraffa, Chiara M., Di Marca, Salvatore, Pulvirenti, Alfredo, Alaimo, Salvatore, Pisano, Marcella, Terranova, Valentina, Corriere, Thea, Ronsisvalle, Maria L., Di Quattro, Rosario, Stancanelli, Benedetta, Giordano, Mauro, Vancheri, Carlo, Malatino, Lorenzo
Předmět:	NEUTROPHILS LYMPHOCYTES COMMUNITY-acquired pneumonia DISEASES in older people COHORT analysis PNEUMONIA diagnosis CHEST X rays ACADEMIC medical centers BIOMARKERS CHI-squared test LONGITUDINAL method PROBABILITY theory T-test (Statistics) EFFECT sizes (Statistics) PROPORTIONAL hazards models SEVERITY of illness index RECEIVER operating characteristic curves DESCRIPTIVE statistics KAPLAN-Meier estimator LYMPHOCYTE count OLD age PROGNOSIS
Zdroj:	Journal of the American Geriatrics Society; Aug2017, Vol. 65 Issue 8, p1796-1801, 6p, 3 Charts, 1 Graph
Abstrakt:	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. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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