The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia
Objectives: The value of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients hospitalised with community-acquired pneumonia (CAP) remains debated. This study evaluated whether NLR independently predicts clinical outcomes and enhances the predictive performance of the CURB-65...
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Elsevier
2025-01-01
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| Series: | Clinical Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211824054630 |
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| author | Yogesh Sharma Campbell Thompson Angelo Zinellu Rashmi Shahi Chris Horwood Arduino A. Mangoni |
| author_facet | Yogesh Sharma Campbell Thompson Angelo Zinellu Rashmi Shahi Chris Horwood Arduino A. Mangoni |
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| description | Objectives: The value of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients hospitalised with community-acquired pneumonia (CAP) remains debated. This study evaluated whether NLR independently predicts clinical outcomes and enhances the predictive performance of the CURB-65 score in patients with CAP. Methods: Data from CAP admissions at two Australian hospitals from 2018 to 2023 were analysed. NLR was calculated using admission neutrophil and lymphocyte counts. Patients were categorised into NLR >12 and NLR ≤12. Multilevel-multivariable regression models, adjusting for age, sex, Charlson index, CURB-65 score, Hospital Frailty Risk Score (HFRS) and C-reactive protein (CRP), assessed outcomes including length of stay (LOS), intensive care unit (ICU) admission and in-hospital mortality. Results: Over 6 years, 7,862 patients with CAP were hospitalised (mean age 75.1 years, 54.6% male). Mean NLR was 12.6, with 2,877 (36.6%) patients having an NLR >12. Those with NLR >12 were older males with higher disease severity and Charlson index (p<0.05). Adjusted analyses showed that NLR >12 was independently associated with prolonged LOS (IRR=1.11, 95% CI 1.08–1.13, p<0.001), increased risk of ICU admission (adjusted odds ratio (aOR) =1.41, 95% confidence interval (CI) 1.06–1.88, p=0.019), and higher in-hospital mortality (aOR=1.27, 95% CI 1.06–1.53, p=0.009). The predictive ability of the CURB-65 score for in-hospital mortality was good (area under the curve (AUC) 0.68, 95% CI 0.66–0.70), while it was modest for the NLR (AUC 0.58, 95% CI 0.56–0.60). Incorporation of NLR to the CURB-65 score did not enhance its predictive ability (AUC 0.69, p>0.05). Conclusions: NLR independently predicts adverse outcomes in patients hospitalised with CAP but does not improve the predictive performance of the CURB-65 score. |
| format | Article |
| id | doaj-art-324345d6712f4556a087dda9a2d2ed74 |
| institution | Kabale University |
| issn | 1470-2118 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Clinical Medicine |
| spelling | doaj-art-324345d6712f4556a087dda9a2d2ed742025-02-06T05:11:15ZengElsevierClinical Medicine1470-21182025-01-01251100278The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumoniaYogesh Sharma0Campbell Thompson1Angelo Zinellu2Rashmi Shahi3Chris Horwood4Arduino A. Mangoni5Senior Consultant Physician, Department of Acute and General Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia; College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia; Corresponding author.Prof Campbell Thompson, Professor of Medicine, The University of Adelaide, Adelaide, South Australia, AustraliaDepartment of Biomedical Sciences, University of Sassari, Sassari, ItalyLecturer, College of Medicine & Public Health, Flinders University, Adelaide, South Australia, AustraliaClinical Epidemiologist, Flinders Medical Centre, Flinders Medical Centre, Adelaide, South Australia, AustraliaClinical Pharmacologist, College of Medicine & Public Health, Flinders University, Adelaide, South Australia, AustraliaObjectives: The value of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients hospitalised with community-acquired pneumonia (CAP) remains debated. This study evaluated whether NLR independently predicts clinical outcomes and enhances the predictive performance of the CURB-65 score in patients with CAP. Methods: Data from CAP admissions at two Australian hospitals from 2018 to 2023 were analysed. NLR was calculated using admission neutrophil and lymphocyte counts. Patients were categorised into NLR >12 and NLR ≤12. Multilevel-multivariable regression models, adjusting for age, sex, Charlson index, CURB-65 score, Hospital Frailty Risk Score (HFRS) and C-reactive protein (CRP), assessed outcomes including length of stay (LOS), intensive care unit (ICU) admission and in-hospital mortality. Results: Over 6 years, 7,862 patients with CAP were hospitalised (mean age 75.1 years, 54.6% male). Mean NLR was 12.6, with 2,877 (36.6%) patients having an NLR >12. Those with NLR >12 were older males with higher disease severity and Charlson index (p<0.05). Adjusted analyses showed that NLR >12 was independently associated with prolonged LOS (IRR=1.11, 95% CI 1.08–1.13, p<0.001), increased risk of ICU admission (adjusted odds ratio (aOR) =1.41, 95% confidence interval (CI) 1.06–1.88, p=0.019), and higher in-hospital mortality (aOR=1.27, 95% CI 1.06–1.53, p=0.009). The predictive ability of the CURB-65 score for in-hospital mortality was good (area under the curve (AUC) 0.68, 95% CI 0.66–0.70), while it was modest for the NLR (AUC 0.58, 95% CI 0.56–0.60). Incorporation of NLR to the CURB-65 score did not enhance its predictive ability (AUC 0.69, p>0.05). Conclusions: NLR independently predicts adverse outcomes in patients hospitalised with CAP but does not improve the predictive performance of the CURB-65 score.http://www.sciencedirect.com/science/article/pii/S1470211824054630Community-acquired pneumoniaNeutrophil-to-lymphocyte ratioLength of hospital stayMortality30-day readmissions |
| spellingShingle | Yogesh Sharma Campbell Thompson Angelo Zinellu Rashmi Shahi Chris Horwood Arduino A. Mangoni The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia Clinical Medicine Community-acquired pneumonia Neutrophil-to-lymphocyte ratio Length of hospital stay Mortality 30-day readmissions |
| title | The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia |
| title_full | The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia |
| title_fullStr | The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia |
| title_full_unstemmed | The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia |
| title_short | The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia |
| title_sort | role of the neutrophil to lymphocyte ratio in predicting outcomes among patients with community acquired pneumonia |
| topic | Community-acquired pneumonia Neutrophil-to-lymphocyte ratio Length of hospital stay Mortality 30-day readmissions |
| url | http://www.sciencedirect.com/science/article/pii/S1470211824054630 |
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