Yıl: 2021 Cilt: 36 Sayı: 2 Sayfa Aralığı: 130 - 137 Metin Dili: İngilizce DOI: 10.5222/MMJ.2021.64160 İndeks Tarihi: 02-02-2022

The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care

Öz:
Objective: In this study, we aimed to reveal the level of predicting mortality of the Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (TLR) calculated in patients hospitalized with the diagnosis of pneumonia in the intensive care unit when compared with other prognostic scores. Method: The hospital records of 112 patients who were admitted to the intensive care unit between January 2015 and January 2018 and met the inclusion criteria were retrospectively reviewed. The patients’ demographic data, the NLR and PLR levels, and the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores were calculated from the patient files. Results: Of the 112 patients examined, 70 were males. The risk analysis showed that the male gender had 2.7 times higher risk of mortality. The NLR, PLR, APACHE II, and SOFA values were found statistically significant in predicting mortality (p<0.001). An evaluation of the risk ratios demonstrated that each one point increase in the NLR increased the mortality risk by 5%, and each one point increase in the SOFA score increased the mortality risk by 13% (p<0.05). In the ROC (receiver operating characteristic) analysis, the NLR assessment proved to be the most powerful, most specific, and sensitive test. The cut-off values were 11.3 for the NLR, 227 for the PLR, 29.8 for the APACHE II scores, and 5.5 for the SOFA scores. Conclusion: We believe that NLR and PLR are strong and independent predictors of mortality that can be easily and cost-effectively tested.
Anahtar Kelime:

Yoğun Bakımda Pnomoni Tanılı Hastalarda Nötrofil-Lenfosit Oranının, Trombosit-Lenfosit Oranının ve Prognostik Belirteçlerin Mortaliteyi Belirleme Üzerine Etkileri

Öz:
Amaç: Bu çalışmada, yoğun bakıma pnömoni tanısı ile yatırılmış hastalarda hesaplanan Nötrofil/Len- fosit Oranı (NLO) ve Trombosit/Lenfosit Oranı (TLO)’nun; diğer prognostik skorlarla karşılaştırıldığında mortaliteyi belirleme düzeyini ortaya koymak amaçlanmıştır. Yöntem: Ocak 2015 ile Ocak 2018 arasında yoğun bakım ünitesine kabul edilen ve çalışmamıza dahil olma kriterlerini sağlayan toplam 112 hastanın hastane kayıtları retrospektif olarak incelendi. Demografik veriler kaydedildi; NLO, TLO, APACHE II (Akut Fizyoloji ve Sağlık Değerlendirmesi Skoru II) ve SOFA (Ardışık Organ Yetmezliği Değerlendirme Skoru) skorları kayıtlardan hesaplandı. Bulgular: İncelenen 112 hastanın 70’i erkekti. Bakılan risk analizinde erkek cinsiyetin 2,7 kat daha fazla mortalite riskine sahip olduğu anlaşıldı. NLO, TLO, APACHE II ve SOFA’nın mortaliteyi belirlemede ista- tistiksel olarak anlamlı olduğu tespit edildi (p<0,001). Risk oranlarına bakıldığında her 1 birim NLO’nın %5, SOFA’nın ise %13 mortalite riskini artırdığı belirlendi (p<0,05). Yapılan ROC (Alıcı işletim karakteris- tiği) analizinde ise NLO en güçlü, en spesifik ve sensitif test olarak bulundu. Cut-off değerleri; NLO’nun 11,3, APACHE II’nin 29,8, TLO’nun 227 ve SOFA’nın ise 5,5 olarak belirlendi. Sonuç: NLO ve TLO’nun iyi bir mortalite belirleyicisi olmakla birlikte, basit, ucuz, hızlı ve bağımsız bir gösterge olduğunu düşünmekteyiz.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981;9:591-7. [CrossRef]
  • 2. Maccariello ER, Valente C, Nogueira L, et al. Performance of six prognostic scores in critically ILL patients receiving renal replacement therapy. Rev Bras Ter Intensiva. 2008;20:115-23. [CrossRef]
  • 3. Pettilä V, Pettilä M, Sarna S, Voutilainen P, Takkunen O. Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill. Crit Care Med. 2002;30:1705-11. [CrossRef]
  • 4. Shimoyama Y, Umegaki O, Agui T, Kadono N, Minami T. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are superior to other inflammation- based prognostic scores in predicting the mortality of patients with gastrointestinal perforation. JA Clin Reports. 2017;3:49. [CrossRef]
  • 5. Akilli NB, Yortanlı M, Mutlu H, et al. Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes. Am J Emerg Med. 2014;32:1476-80. [CrossRef]
  • 6. Kayrak M, Erdoğan Hİ, Solak Y, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Hear Lung Circ. 2014;23:56-62. [CrossRef]
  • 7. Azab B, Jaglall N, Atallah JP, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology. 2011;11:445-52. [CrossRef]
  • 8. Velissaris D, Pantzaris ND, Bountouris P, Gogos C. Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients. Rom J Intern Med. 2018;56:153-7. [CrossRef]
  • 9. Kumar P, Law S, Sriram KB. Evaluation of platelet lymphocyte ratio and 90-day mortality in patients with acute exacerbation of chronic obstructive pulmonary disease. J Thorac Dis. 2017;9:1509-16. [CrossRef]
  • 10. Rajagopal P, Ramamoorthy S, Grace Jeslin A. Utility of haemogram parameters in mortality risk prediction of critically ill patients. J Evol Med Dent Sci. 2018;7:1024-9. [CrossRef]
  • 11. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community- acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27-72. [CrossRef]
  • 12. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29. [CrossRef]
  • 13. Karabiyik L. Scoring systems in intensive care. Journal of Intensive Care. 2010;9:129-43. [CrossRef]
  • 14. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis- related Organ Failure Assessment) score to describe organ dysfunction/failure: On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707-10. [CrossRef]
  • 15. 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. [CrossRef]
  • 16. Christ-Crain M, Muller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J. 2007;30:556-73. [CrossRef]
  • 17. Kopterides P, Siempos II, Tsangaris I, Tsantes A, Armaganidis A. Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: A systematic review and meta-analysis of randomized controlled trials. Crit Care Med. 2010;38:2229-41. [CrossRef]
  • 18. Zahorec R. Ratio of neutrophil to lymphocyte counts-- rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5-14. PMID: 11723675.
  • 19. Wyllie DH, Bowler ICJW, Peto TEA. Relation between lymphopenia and bacteraemia in UK adults with medical emergencies. J Clin Pathol. 2004;57:950-5. [CrossRef]
  • 20. de Jager CPC, van Wijk PTL, Mathoera RB, de Jongh- Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14:R192. [CrossRef]
  • 21. von Hundelshausen P, Weber C. Platelets as immune cells. Circ Res. 2007;100:27-40. [CrossRef]
  • 22. Van der Lelie J, Von dem Borne AK. Increased mean platelet volume in septicaemia. J Clin Pathol. 1983;36:693-6. [CrossRef]
  • 23. Zheng C-F, Liu W-Y, Zeng F-F, et al. Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury. Crit Care. 2017;21:238. [CrossRef]
  • 24. Kaushik R, Gupta M, Sharma M, et al. Diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in early and late phase of sepsis. Indian J Crit Care Med. 2018;22:660-3. [CrossRef]
  • 25. Wang Y, Ju M, Chen C, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective study. J Thorac Dis. 2018;10:273-82. [CrossRef]
  • 26. Yildiz A, Yigit A, Benli AR. The impact of nutritional status and complete blood count parameters on clinical outcome in geriatric critically ill patients. J Clin Med Res. 2018;10:588-92. [CrossRef]
  • 27. Xiong W, Xu M, Zhao Y, Wu XL, Pudasaini B, Liu JM. Can we predict the prognosis of COPD with a routine blood test? Int J Chron Obstruct Pulmon Dis. 2017;12:615-25. [CrossRef]
  • 28. Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU - APACHE II, SOFA or SAP II! Pakistan J Med Sci. 2016;32:1146-51. [CrossRef]
APA Altaş Ö, kızılkaya m (2021). The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. , 130 - 137. 10.5222/MMJ.2021.64160
Chicago Altaş Ömer Faruk,kızılkaya mehmet The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. (2021): 130 - 137. 10.5222/MMJ.2021.64160
MLA Altaş Ömer Faruk,kızılkaya mehmet The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. , 2021, ss.130 - 137. 10.5222/MMJ.2021.64160
AMA Altaş Ö,kızılkaya m The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. . 2021; 130 - 137. 10.5222/MMJ.2021.64160
Vancouver Altaş Ö,kızılkaya m The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. . 2021; 130 - 137. 10.5222/MMJ.2021.64160
IEEE Altaş Ö,kızılkaya m "The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care." , ss.130 - 137, 2021. 10.5222/MMJ.2021.64160
ISNAD Altaş, Ömer Faruk - kızılkaya, mehmet. "The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care". (2021), 130-137. https://doi.org/10.5222/MMJ.2021.64160
APA Altaş Ö, kızılkaya m (2021). The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. Medeniyet Medical Journal, 36(2), 130 - 137. 10.5222/MMJ.2021.64160
Chicago Altaş Ömer Faruk,kızılkaya mehmet The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. Medeniyet Medical Journal 36, no.2 (2021): 130 - 137. 10.5222/MMJ.2021.64160
MLA Altaş Ömer Faruk,kızılkaya mehmet The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. Medeniyet Medical Journal, vol.36, no.2, 2021, ss.130 - 137. 10.5222/MMJ.2021.64160
AMA Altaş Ö,kızılkaya m The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. Medeniyet Medical Journal. 2021; 36(2): 130 - 137. 10.5222/MMJ.2021.64160
Vancouver Altaş Ö,kızılkaya m The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. Medeniyet Medical Journal. 2021; 36(2): 130 - 137. 10.5222/MMJ.2021.64160
IEEE Altaş Ö,kızılkaya m "The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care." Medeniyet Medical Journal, 36, ss.130 - 137, 2021. 10.5222/MMJ.2021.64160
ISNAD Altaş, Ömer Faruk - kızılkaya, mehmet. "The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care". Medeniyet Medical Journal 36/2 (2021), 130-137. https://doi.org/10.5222/MMJ.2021.64160