https://doi.org/10.4081/monaldi.2021.2050

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

Vol. 92 No. 3 (2022)
Submitted: August 13, 2021
Accepted: November 16, 2021
Published: December 13, 2021
Neutrophil to lymphocyte ratio, NLR, Community acquired pneumonia, CAP, Mortality, Prognosis
Abstract Views: 2567
PDF: 1128
Supplementary 1: 113
Supplementary 2: 93
Data Analysis: 163
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Osama Alzoubi
osama-alzoubi@hotmail.com
https://orcid.org/0000-0001-8196-3922
School of Medicine, University of Jordan, Amman, Jordan.
Asim Khanfar
https://orcid.org/0000-0002-4754-9872
School of Medicine, University of Jordan, Amman, Jordan.

The neutrophil to lymphocyte ratio (NLR) is an emerging biomarker used in the prognosis of many conditions. We aimed to conduct a meta-analysis to assess the prognostic accuracy of the NLR in determining mortality in patients with community acquired pneumonia (CAP). The PubMed, EBSCO, and Scopus databases were searched to find all relevant articles; 10 articles with 5220 patients were included. The pooled area under the curve (AUC) of NLR admission levels to predict 30-Day mortality of CAP patients was 0.706; 95% CI (0.631 to 0.781), while the pooled AUC of NLR levels taken at 3-5 days was 0.882; 95% CI (0.818 to 0.945). Meta analysis also showed a significant difference in the NLR between the survivors and 30-day non-survivors. This difference was greater when NLR levels were taken at 3-5 days; standardized mean difference (SMD) = 1.646; 95% CI (0.451 to 2.840) compared to NLR levels at admission SMD = 1.139; 95% CI (0.514 to 1.764). These results show that the NLR has potential to be incorporated in the routine assessment and stratification of CAP patients, especially in the early-stage evolution (3-5 days), keeping in mind the availability and cost effectiveness of this test.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Wunderink RG, Waterer GW. Clinical practice. Community-acquired pneumonia. N Engl J Med 2014;370:543–51. DOI: https://doi.org/10.1056/NEJMcp1214869
Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 2015;373:415–27. DOI: https://doi.org/10.1056/NEJMc1511751
Pfuntner A, Wier LM, Stocks C. Most frequent conditions in US hospitals, 2011: statistical brief# 162. 2013;
Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 2012;67:71. DOI: https://doi.org/10.1136/thx.2009.129502
Lim WS. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377–82. DOI: https://doi.org/10.1136/thorax.58.5.377
Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243–50. DOI: https://doi.org/10.1056/NEJM199701233360402
Chalmers JD, Singanayagam A, Akram AR, et al. Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax 2010;65:878. DOI: https://doi.org/10.1136/thx.2009.133280
Yandiola PPE, Capelastegui A, Quintana J, et al. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest 2009;135:1572–9. DOI: https://doi.org/10.1378/chest.08-2179
Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008;121:219–25. DOI: https://doi.org/10.1016/j.amjmed.2007.10.033
Schuetz P, Suter-Widmer I, Chaudri A, et al. Prognostic value of procalcitonin in community-acquired pneumonia. Eur Respir J 2011;37:384. DOI: https://doi.org/10.1183/09031936.00035610
Kolditz M, Halank M, Schulte-Hubbert B, et al. Copeptin predicts clinical deterioration and persistent instability in community-acquired pneumonia. Respir Med. 2012;106:1320–8. DOI: https://doi.org/10.1016/j.rmed.2012.06.008
Huang DT, Angus DC, Kellum JA, et al. Midregionalproadrenomedullin as a prognostic tool in community-acquired pneumonia. Chest. 2009;136:823–31. DOI: https://doi.org/10.1378/chest.08-1981
Krüger S, Ewig S, Giersdorf S, et al. Cardiovascular and inflammatory biomarkers to predict short-and long-term survival in community-acquired pneumonia: Results from the German Competence Network, CAPNETZ. Am J Respir Crit Care Med 2010;182:1426–34. DOI: https://doi.org/10.1164/rccm.201003-0415OC
Kong W, He Y, Bao H, et al. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: ameta-analysis. Dis Markers 2020;2020:9731854. DOI: https://doi.org/10.1155/2020/9731854
Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol J Int Union Angiol 2017;37:4–11. DOI: https://doi.org/10.23736/S0392-9590.17.03848-2
Ye Z, Ai X, Liao Z, et al. The prognostic values of neutrophil to lymphocyte ratio for outcomes in chronic obstructive pulmonary disease. Medicine (Baltimore) 2019;98:e16371. DOI: https://doi.org/10.1097/MD.0000000000016371
Rha M-S, Kim C-H, Yoon J-H, Cho H-J. Association between the neutrophil-to-lymphocyte ratio and obstructive sleep apnea: a meta-analysis. Sci Rep 2020;10:10862. DOI: https://doi.org/10.1038/s41598-020-67708-w
de Jager CPC, Wever PC, Gemen EFA, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One 2012;7:e46561. DOI: https://doi.org/10.1371/journal.pone.0046561
Zhang HF, Ge YL, Wang HY, et al. Neutrophil-to-lymphocyte ratio improves the accuracy and sensitivity of pneumonia severity index in predicting 30-day mortality of CAP patients. Clin Lab 2019;65:190226. DOI: https://doi.org/10.7754/Clin.Lab.2019.190226
Cataudella E, Giraffa CM, Di Marca S, et al. Neutrophil-to-lymphocyte ratio: an emerging marker predicting prognosis in elderly adults with community-acquired pneumonia. J Am Geriatr Soc 2017;65:1796–801. DOI: https://doi.org/10.1111/jgs.14894
Avci S, Perincek G. The alveolar-arterial gradient, pneumonia severity scores and inflammatory markers to predict 30-day mortality in pneumonia. Am J Emerg Med 2020;38:1796–801. DOI: https://doi.org/10.1016/j.ajem.2020.05.048
Lee H, Kim I, Kang BH, Um S-J. Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia. PLoS One 2021;16:0250067. DOI: https://doi.org/10.1371/journal.pone.0250067
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Med 2009;6:e1000097. DOI: https://doi.org/10.1371/journal.pmed.1000097
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010;25:603–5. DOI: https://doi.org/10.1007/s10654-010-9491-z
Yi-fan L, Chang-yuan Li W. Application value of neutrophil to lymphocyte ratio for the elderly patients with community acquired pneumonia in emergency department. Progress in Modern Biomedicine 2021;21:455-8.
Curbelo J, Luquero Bueno S, Galván-Román JM, et al. Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio. PLoS One 2017;12:e0173947. DOI: https://doi.org/10.1371/journal.pone.0173947
Curbelo J, Rajas O, Arnalich B, et al. Neutrophil count percentage and neutrophil–lymphocyte ratio as prognostic markers in patients hospitalized for community-acquired pneumonia. Arch Bronconeumol 2019;55:472–7. DOI: https://doi.org/10.1016/j.arbr.2019.07.002
Ozmen I, Karakurt Z, Salturk C, et al. Can N-terminal pro B-type natriuretic peptide, neutrophil-to-lymphocyte ratio, C-reactive protein help to predict short and long term mortality? Bratisl Med J 2017;117:587–94. DOI: https://doi.org/10.4149/BLL_2016_114
Feng D-Y, Zou X-L, Zhou Y-Q, et al. Combined neutrophil-to-lymphocyte ratio and CURB-65 score as an accurate predictor of mortality for community-acquired pneumonia in the elderly. Int J Gen Med 2021;14:1133–9. DOI: https://doi.org/10.2147/IJGM.S300776
Cheng S, Hou G, Liu Z, et al. Risk prediction of in-hospital mortality among patients with type 2 diabetes mellitus and concomitant community-acquired pneumonia. Ann Palliat Med 2020;9:3313–25. DOI: https://doi.org/10.21037/apm-20-1489
Hosmer DW, Lemeshow S. Chapter 5. In: Applied Logistic Regression. 2nd edition. New York: J. Wiley & Sons; 2000. p. 160–4. DOI: https://doi.org/10.1002/0471722146
Ananda-Rajah MR, Charles PGP, Melvani S, et al. Comparing the pneumonia severity index with CURB-65 in patients admitted with community acquired pneumonia. Scand J Infect Dis 2008;40:293–300. DOI: https://doi.org/10.1080/00365540701663381

How to Cite

Alzoubi, Osama, and Asim Khanfar. 2021. “Association Between Neutrophil to Lymphocyte Ratio and Mortality Among Community Acquired Pneumonia Patients: A Meta-Analysis”. Monaldi Archives for Chest Disease 92 (3). https://doi.org/10.4081/monaldi.2021.2050.
Copyright (c) 2021 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.