The effect of C-reactive protein, procalcytonine, nuetrophil/lymphosite levels on mortality and duration of hospital stay in pneumonia

Abstract

Aim: The aim of this study is to investigate the effects of procalcitonin (PCT), C-reactive protein (CRP) and neutrophil lymphocyte ratio (NLR) levels on the mortality and duration of hospital stay in patients diagnosed with pneumonia. Material and Method: The study included 111 cases of pneumonia followed in our chest diseases service and intensive care unit between 2017 and 2018. Collected data included demographic information, NLR, PCT, CURB-65 scores. The data were evaluated by parametric tests (Paired sample T test, Independent sample T test). Correlation between the data was done by Chi-square test. P value <0.05 was considered statistically significant. Results: A statistically significant positive correlation was detected between PCT and NLR (p <0.001; r = 0.343), PCT and CRP (p <0.001; r = 0.502), NLR and CRP (p <0.001; r = 0.427). There was a statistically significant correlation between mortality and CRP (p <0.001; 0.427), PCT (p <0.001; r = 0.343) and NLR (p = 0.013; r = 0.235). There was a statistically significant correlation between duration of hospital stay and PCT (p = 0.036; r = 0.199) and NLR (p = 0.030; r = 0.206) but not with CRP (p = 0.298; r = 0.102). Conclusion: Besides PCT and CRP, NLR can also be used for prognosis estimation in pneumonia patients.

Keywords

• C-reactive protein
• neutrophil lymphocyte ratio
• procalcitonin

References

1. Özlü T, Bülbül Y, Ozsu S. Community-acquired pneumonia based on the Turkish national data. Tuberk Toraks 2007; 55: 191-212.
2. Bates JH, Campbell GD, Barron AL, et al. Microbial etiology of acute pneumonia in hospitalized patients. Chest 1992; 101: 1005-12.
3. Fang GD, Fine M, Orloff J, et al. New and emerging etiologies for communityacquired pneumonia with implications for therapy; a prospective multicenter study of 359 cases. Medicine 1990; 69: 307-16.
4. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341: 515-8.
5. Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents 2002; 20: 1-9.
6. Shehabi Y, Seppelt I. Pro/Con debate: Is procalcitonin useful for guiding antibiotic decision making in critically ill patients? Critical Care 2008; 12: 211.
7. Thompson D, Pepys MB, Wood SP. The physiological stucture of human C- reactive protein and its complex with phosphocholine. Structure 1999; 7: 169-77.
8. Jilma B, Blann A, Pernerstorfer T, et al. Regulation of adhesion molecules during human endotoxemia. No acute effects of aspirin. Am J Respir Crit Care Med 1999; 159: 857-63.

9. 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.
10. Şimşek S, Yurtseven N, Gerçekoğlu H, et al. Ventilator associated pneumonias in a cardiothoracic surgery centre postoperative intensive care unit. J Hosp Infect 2001; 47: 321-4.
11. Aybar M, Topeli A. Dahili yoğun bakım ünitesinde ventilatörle ilişkili pnömoni epidemiyolojisi. Yoğun Bakım Derg 2001; 1: 41- 6.
12. Çevik MA, Yılmaz GR, Erdinç FŞ, et al. Nöroloji Yoğun Bakım Ünitesinde mortalite ile ilişkili faktörler ve nozokomiyal enfeksiyonla mortalitenin ilişkisi. Yoğun Bakım Derg 2001; 1: 47-55.
13. Cazzola M, Centanni S, Blasi F. Have guidelines for the management of community-acquired pneumonia influenced outcomes? Respir Med 2003; 97: 205-11.
14. Sever F, Kömüs N, Esen N, Gündüz AT, Öktem MA, Çımrın AH. Türkiye’de toplum kökenli pnömoni etyoloji ve epidemiyolojisi. Turk Toraks Derg 2013; 14: 5-10.
15. Bircan A, Kaya Ö, Gökırmak M, Öztürk Ö, Sahin Ü, Akkaya A. Toplum kökenli pnömonilerin ağırlığının değerlendirilmesinde C-reaktif protein, lökosit sayısı ve eritrosit sedimentasyon hızının yeri. Tuberk Toraks 2006; 54: 22-9.
16. Fukuyama H, Ishida, Tachibana H, et al. Validation of scoring systems for predicting severe community-acquired pneumonia. Intern Med 2011; 50: 1917-22.
17. 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.
18. Murphy TF, Parameswaran GI. Moraxella catarrhalis, a human respiratory tract pathogen. Clin Infect Dis 2009; 49: 124-31.
19. Bircan A, Sutcu R, Gokırmak M. Total antioxidant capacity and C-reactive protein levels in patients with community-acquired pneumonia. Turk J Med Sci 2008; 38: 537-44.
20. Doruk S, Bulaç S, Sevinç C, Bodur HA, Yilmaz A, Erkorkmaz U. Severity scores and factors related with mortality in cases with community-acquired pneumonia patients in intensive care unit. Tuberk Toraks 2009; 57: 393-400.
21. Aujesky D, Auble TE, Yealy DM, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005; 118: 384-92.
22. Man SY, Lee N, Ip M, et al. Prospective comparison of three predictive rules for assessing severity of community acquired pneumonia in Hong Kong. Thorax 2007; 62: 348-53.
23. Shah BA, Ahmed W, Dhobi GN, Shah NN, Khursheed SQ, Haq I. Validity of pneumonia severity index and CURB-65 severity scoring systems in community acquired pneumonia in an Indian setting. Indian J Chest Dis Allied Sci 2010; 52: 9-17.
24. Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, Bienvenu J. Procalcitonin and C-reactive protein levels in neonatal infections. Acta Paediatr 1997; 86: 209-12.