TY - JOUR

T1 - The ratio of neutrophil-to-lymphocyte and platelet-to-lymphocyte and association with mortality in community-acquired pneumonia

T2 - a derivation-validation cohort study

AU - Enersen, Christian Cosmus

AU - Egelund, Gertrud Baunbæk

AU - Petersen, Pelle Trier

AU - Andersen, Stine

AU - Ravn, Pernille

AU - Rohde, Gernot

AU - Lindegaard, Birgitte

AU - Jensen, Andreas Vestergaard

N1 - Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

PY - 2023

Y1 - 2023

N2 - Rationale: The ratio of neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and platelet-to-lymphocyte (PLR) are biomarkers that have shown potential for predicting mortality in several diseases. For patients hospitalized with community-acquired pneumonia (CAP), the prognostic capabilities of these biomarkers are unknown. Objective: Investigate whether NLR, MLR or PLR were associated with 90-day mortality in CAP. Further, investigate whether the prediction rule CURB-65 could be improved by adding these biomarkers. Methods: A derivation-validation study using a Danish multicentre retrospective cohort as the derivation cohort (N = 831) and a European multicentre prospective cohort as the validation cohort (N = 2463). Associations between biomarkers and mortality were assessed using Cox proportional hazard models with adjustments for sex, CURB-65 and comorbidities. A cut-off value for biomarkers was determined using Youden’s J Statistics. The performance of CURB-65 with added biomarkers was evaluated using receiver-operating characteristics. Results: In both cohorts increasing NLR and PLR were associated with 90-day mortality. In the derivation cohort, the hazard ratios for NLR and PLR were 1.016 (95% confidence interval (CI) 1.001–1.032, P = 0.038) and 1.001 (95% CI 1.000–1.001, P = 0.035), respectively. Adding these biomarkers to CURB-65 did not improve its performance. Conclusions: NLR and PLR were associated with 90-day mortality in CAP, but did not improve CURB-65.

AB - Rationale: The ratio of neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and platelet-to-lymphocyte (PLR) are biomarkers that have shown potential for predicting mortality in several diseases. For patients hospitalized with community-acquired pneumonia (CAP), the prognostic capabilities of these biomarkers are unknown. Objective: Investigate whether NLR, MLR or PLR were associated with 90-day mortality in CAP. Further, investigate whether the prediction rule CURB-65 could be improved by adding these biomarkers. Methods: A derivation-validation study using a Danish multicentre retrospective cohort as the derivation cohort (N = 831) and a European multicentre prospective cohort as the validation cohort (N = 2463). Associations between biomarkers and mortality were assessed using Cox proportional hazard models with adjustments for sex, CURB-65 and comorbidities. A cut-off value for biomarkers was determined using Youden’s J Statistics. The performance of CURB-65 with added biomarkers was evaluated using receiver-operating characteristics. Results: In both cohorts increasing NLR and PLR were associated with 90-day mortality. In the derivation cohort, the hazard ratios for NLR and PLR were 1.016 (95% confidence interval (CI) 1.001–1.032, P = 0.038) and 1.001 (95% CI 1.000–1.001, P = 0.035), respectively. Adding these biomarkers to CURB-65 did not improve its performance. Conclusions: NLR and PLR were associated with 90-day mortality in CAP, but did not improve CURB-65.

KW - Community-acquired pneumonia

KW - Mortality

KW - Neutrophil-to-lymphocyte ratio

U2 - 10.1007/s15010-023-01992-2

DO - 10.1007/s15010-023-01992-2

M3 - Journal article

C2 - 36763284

AN - SCOPUS:85147747788

VL - 51

SP - 1339

EP - 1347

JO - Therapies

JF - Therapies

SN - 0300-8126

IS - 5

ER -