https://doi.org/10.4081/monaldi.2021.2050
Association between neutrophil to lymphocyte ratio and mortality among community acquired pneumonia patients: a meta-analysis
Submitted: August 13, 2021
Accepted: November 16, 2021
Published: December 13, 2021
Accepted: November 16, 2021
Abstract Views: 2789
PDF: 1223
Supplementary 1: 117
Supplementary 2: 97
Data Analysis: 170
Supplementary 1: 117
Supplementary 2: 97
Data Analysis: 170
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.
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
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.
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)
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.
Similar Articles
- Vincenzo Capuano, Norman Lamaida, Sergio Torre, Ernesto Capuano, Maria Immacolata Borrelli, Eduardo Capuano, Maria Maddalena Clarizia, Rocco Capuano, Carmela De Rosa, Ten year cardio-cerebro-vascular mortality and morbidity in a Southern Italy cohort: the VIP Project data , Monaldi Archives for Chest Disease: Vol. 80 No. 1 (2013): Cardiac series
- Andrea Imperatori, Maria Cattoni, Luca Bertolaccini, Mario Nosotti, Lorenzo Rosso, Lucio Cagini, Jacopo Vannucci, Alessandro Brunelli, Roberto Crisci, Carlo Curcio, Nicola Rotolo, Assessment of the 90-day mortality risk score after video-assisted thoracoscopic lobectomy in the Italian VATS Group cohort , Monaldi Archives for Chest Disease: Vol. 94 No. 2 (2024)
- Yamini Marimuthu, Radhika Kunnavil, NS Anil, Sharath Burugina Nagaraja, N Satyanarayana, Jeetendra Kumar, Bojja Ramya, Clinical profile and risk factors for mortality among COVID-19 inpatients at a tertiary care centre in Bengaluru, India , Monaldi Archives for Chest Disease: Vol. 91 No. 3 (2021)
- Antonino Capizzi, Oliviero Sacco, Giovanni A. Rossi, Michela Silvestri, Recurrence of right lower lobe pneumonia 3 years after the first episode in an otherwise healthy 13-year-old girl , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Marzia Vassalini, Andrea Verzeletti, Francesco De Ferrari, Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications , Monaldi Archives for Chest Disease: Vol. 84 No. 1-2 (2015): Cardiac series
- Domenico Scrutinio, Fabio Bellotto, Rocco Lagioia, Andrea Passantino, Physical activity for coronary heart disease: cardioprotective mechanisms and effects on prognosis , Monaldi Archives for Chest Disease: Vol. 64 No. 2 (2005): Cardiac series
- Yaser Jenab, Marzieh Pourjafari, Maryam Sotoudeh, Masoumeh Lotfi-tokaldany, Nasrin Etesamifard, Shapour Shirani, Arash Jalali, Younes Nozari, Hamid-reza Poorhosseini, Comparing the effect of cardiac biomarkers on the outcome of normotensive patients with acute pulmonary embolism , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Karrar Al-Buthabhak , Hussein Nafakhi, Mohammed H. Shukur , Ahmed Nafakhi, Mohammed Alareedh, Foaad Shaghee, Blood indices, in-hospital outcome and short-term prognosis in patients with COVID-19 pneumonia , Monaldi Archives for Chest Disease: Vol. 91 No. 2 (2021)
- Donatella Del Sindaco, Giovanni Pulignano, Andrea Di Lenarda, Luigi Tarantini, Giovanni Cioffi, Stefano Tolone, Maria Denitza Tinti, Luca Monzo, Giulia Barbati, Giovanni Minardi, Role of a multidisciplinary program in improving outcomes in cognitively impaired heart failure older patients , Monaldi Archives for Chest Disease: Vol. 78 No. 1 (2012): Cardiac series
- Chiara Pedone, Stefano Urbinati, Maria Giovanna Pallotti, Giuseppe Pinelli, Obesity and cardiovascular disease: expected and unexpected relationship , Monaldi Archives for Chest Disease: Vol. 64 No. 1 (2005): Cardiac series
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
