Is There a Relationship Between Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Neutrophil-Platelet Ratio and Prognosis in Geriatric Patients Diagnosed with Pneumonia in the Intensive Care Unit?

Yıl 2024, , 69 - 73, 31.08.2024

Melek Doğancı , Merve Sarıyıldız Pehlivan , Mustafa Özgür Cırık , Güler Eraslan Doğanay , Oya Kaybal , Gülay Ülger , Ali Alagöz , Hilal Sazak , Metin Tahhan

https://doi.org/10.20492/aeahtd.1433805

Öz

ABSTRACT
Objective: In the intensive care unit (ICU), especially in geriatric patients, the early detection of systemic inflammation and infection impacts the success of treatment and mortality. Nowadays, methods that are cost-effective, rapid, and easy to perform are preferred for this detection. This study aims to assess the prognostic significance of the neutrophil-lymphocyte ratio (NLR), neutrophil-platelet ratio (NPR) and platelet-lymphocyte ratio (PLR) in geriatric patients admitted to the ICU due to pneumonia.
Method: From January 1, 2017 to January 1, 2020, 176 patients aged 65 and above, who were admitted to the ICU due to pneumonia, were retrospectively examined. Demographic data, Sequential Organ Failure Assessment Score (SOFA), Charlson Comorbidity Index Score (CCIS), Acute Physiology And Chronic Health Evaluation-II (APACHE II), duration of ICU stay, length of hospital stay, and 1-month mortality status were documented. The relationship between prognosis and mortality was assessed in relation to the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and neutrophil-platelet ratio (NPR) values, which were determined based on the absolute neutrophil, lymphocyte, and platelet assessments acquired during ICU admissions.
Results: A statistically noteworthy and moderate positive correlation was observed between NLR (r:0.33; p<0.05) and NPR values and SOFA score. Furthermore, there was a statistically notable positive correlation at a low level (r:0.2; p<0.05) between NPR and CCIS score. Additionally, NPR values were significantly elevated in patients who experienced mortality within one month (p<0.05). Moreover, NLR and PLR values were found to be elevated in patients diagnosed with COPD (p<0.05).
Conclusion: Based on our study's findings, the positive correlations observed between NPR and CCIS, as well as between NPR and NLR in conjunction with the SOFA score, imply that elevated NLR and NPR values may serve as valuable indicators for assessing the prognosis of elderly patients admitted to the ICU with pneumonia.
Key words: Geriatric patient, neutrophil-lymphocyte ratio, neutrophil-platelet ratio, pneumonia, platelet-lymphocyte ratio

Anahtar Kelimeler

Geriatric patient, neutrophil-lymphocyte ratio, neutrophil-platelet ratio, pneumonia, platelet-lymphocyte ratio

Yoğun Bakımda Pnömoni Tanılı Geriatrik Hastalarda Prognozun Nötrofil-Lenfosit Oranı, Trombosit-Lenfosit Oranı ve Nötrofil-Trombosit Oranı ile İlişkisi Var mıdır?

Öz

ÖZET
Amaç:
Yoğun bakım ünitesinde (YBÜ) özellikle geriatrik hastalarda sistemik inflamasyon ve enfeksiyonun erken dönemde saptanması tedavi başarısını ve mortaliteyi etkilemektedir. Bunun saptanması için günümüzde ucuz, hızlı ve kolay bir şekilde bakılan yöntemler tercih edilmektedir. Bu çalışmada pnömoni nedeni ile yoğun bakım ünitesine kabul edilen geriatrik hastaların nötrofil-lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR) ve nötrofil-trombosit oranı (NPR) değerlerinin prognoz açısından değerlendirilmesi amaçlanmıştır.
Yöntem: 1 Ocak 2017-1 Ocak 2020 tarihleri arasında pnömoni nedeni ile YBÜ’ye yatırılan 65 yaş ve üstü 176 hasta retrospektif olarak incelendi. Akut Fizyoloji Ve Kronik Sağlık Değerlendirmesi-II (APACHE II), Demografik veriler ve Charlson Komorbidite İndeks Skoru (CCIS), YBÜ yatış süresi, Ardışık Organ Yetmezliği Değerlendirme Skoru (SOFA), hastane yatış süresi ve 1 aylık mortalite durumları kaydedildi. YBÜ yatışları sırasında bakılan mutlak nötrofil, lenfosit ve trombosit değerleri ile hesaplanan NLR PLR ve NPR değerlerinin prognoz ve mortalite ile ilişkisi değerlendirildi.
Bulgular: Çalışmamızda NLR (r:0,33; p<0,05) ve NPR değeri ile SOFA skoru arasında pozitif yönde orta düzeyde (r:0,36; p<0.05) istatistiksel olarak anlamlı bir ilişki görüldü. NPR ve CCIS skoru arasında pozitif yönde düşük düzeyde (r:0,2; p<0.05) istatistiksel olarak anlamlı bir ilişki görüldü. Bir ay içinde exitus olan hastalarda NPR değerlerinin daha yüksek saptandı (p<0,05). KOAH olan hastalarda NLR ve PLR değerlerinin daha yüksek olduğu görüldü (p<0,05).
Sonuç: Çalışmamızda NPR ile CCIS arasında ve NPR ve NLR ile SOFA skoru arasında bulduğumuz pozitif ilişki, YBÜ’ye pnömoni nedenli yatışı yapılan geriatrik hastalarda NLR ve NPR değerlerindeki artışın hastaların prognozunun bir göstergesi olarak kullanılabileceğini göstermektedir.
Anahtar kelimeler: Geriatrik hasta, nötrofil-lenfosit oranı, nötrofil-trombosit oranı, pnömoni, trombosit-lenfosit oranı

Anahtar Kelimeler

geriatrik hasta, nötrofil lenfosit oranı, nötrofil trombosit oranı, pnömoni, trombosit lenfosit oranı

Kaynakça

• 1. Cillóniz C, Dominedò C, Pericàs JM, Rodriguez-Hurtado D, Torres A. Community-acquired pneumonia in critically ill very old patients: a growing problem. European Respiratory Review. 2020;29(155):190126.
• 2. Cillóniz C, Torres A, Niederman MS. Management of pneumonia in critically ill patients. BMJ. 2021;375:e065871. doi: 10.1136/bmj- 2021-065871. PMID: 34872910.
• 3. Furman CD, Leinenbach A, Usher R, Elikkottil J, Arnold FW. Pneumonia in older adults. Curr Opin Infect Dis. 2021;34(2):135-41. doi: 10.1097/QCO.0000000000000718.
• 4. Ticona JH, Zaccone VM, McFarlane IM. Community-Acquired Pneumonia: A Focused Review. Am J Med Case Rep. 2021;9(1):45- 52.
• 5. Patel S. Calculated decisions: CURB-65 score for pneumonia severity. Emerg Med Pract. 2021;23(Suppl 2):CD1-CD2. PMID: 33529515.
• 6. Sarkar R, Martin C, Mattie H, Gichoya JW, Stone DJ, Celi LA. Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study. Lancet Digit Health. 2021;3(4): 241-9.
• 7. Pantzaris ND, Platanaki C, Pierrako C, Karamouzos V, Velissaris D. Neutrophil-to-lymphocyte ratio relation to sepsis severity scores and inflammatory biomarkers in patients with community-acquired pneumonia: a case series. J Transl Int Med. 2018;6(1):43-6.
• 8. Huang Y, Deng W, Zheng S, et al. Relationship between monocytes to lymphocytes ratio and axial spondyloarthritis. Int Immunopharmacol. 2018;57:43-46. doi: 10.1016/j.intimp.2018.02.008.
• 9. El-Gazzar AG, Kamel MH, Elbahnasy OKM, El-Naggar ME. Prognostic value of platelet and neutrophil to lymphocyte ratio in COPD patients. Expert Rev Respir Med. 2020;14(1):111-6. doi: 10.1080/17476348.2019.1675517.
• 10. Lim WS, Van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003; 58(5): 377-82.
• 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. Clinical Infectious Diseases. 2007; 44(2): 27-72. DOI: 10.1086/511159
• 12. Ardestani ME, Naeini NA. Evaluation of the prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute exacerbation of chronic obstructive pulmonary disease. J Res Med Sci. 2022; 27(1):50. doi: 10.4103/jrms.JRMS_512_20.
• 13. Luo Z, Zhang W, Chen L, Xu N. Prognostic Value of Neutrophil: Lymphocyte and Platelet:Lymphocyte Ratios for 28-Day Mortality of Patients with AECOPD. Int J Gen Med. 2021; 14:2839-48. doi: 10.2147/IJGM.S312045.
• 14. Peng Z, Zhang W, Qiao J, He B. Melatonin attenuates airway inflammation via SIRT1 dependent inhibition of NLRP3 inflammasome and IL-1β in rats with COPD. Int Immunopharmacol. 2018;62:23-8.
• 15. Fimognari FL, Corsonello A, Rizzo M, et al. Contribution of clinical severity and geriatric risk factors in predicting short-term mortality of older hospitalized pneumonia patients: the Pneumonia in Italian Acute Care for Elderly units (PIACE) study. Aging Clin Exp Res. 2022;34(6):1419-27. doi:10.1007/s40520-021-02063-y.
• 16. Chopra S, Pednekar S, Karnik ND, Londhe C, Pandey D. A Study of the Outcome of Critically Ill Elderly Patients in a Tertiary Care Hospital Using SOFA Score. Indian J Crit Care Med. 2021;25(6):655-9. doi: 10.5005/jp-journals-10071-23883.
• 17. Drăgoescu AN, Pădureanu V, Stănculescu AD, et al. Neutrophil to Lymphocyte Ratio (NLR)-A Useful Tool for the Prognosis of Sepsis in the ICU. Biomedicines. 2021; 10(1):75. doi:10.3390/biomedicines10010075.
• 18. Li Y, Wang J, Wei B, Zhang X, Hu L, Ye X. Value of Neutrophil:Lymphocyte Ratio Combined with Sequential Organ Failure Assessment Score in Assessing the Prognosis of Sepsis Patients. Int J Gen Med. 2022; 15:1901-8. doi:10.2147/IJGM.S348200.
• 19. 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(3):153-7. doi: 10.2478/rjim-2018-0005.
• 20. Altas OF, Kizilkaya 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. Medeni Med J. 2021;36(2):130-7. doi:10.5222/ MMJ.2021.64160.
• 21. Shi Y, Yang C, Chen L, Cheng M, Xie W. Predictive value of neutrophil- to-lymphocyte and platelet ratio in in-hospital mortality in septic patients. Heliyon. 2022;8(11):e11498.
• 22. Bahlis LF, Diogo LP, Fuchs SC. Charlson Comorbidity Index and other predictors of in-hospital mortality among adults with community- acquired pneumonia. J Bras Pneumol. 2021; 47(1):e20200257. doi:10.36416/1806-3756/e20200257.
• 23. Nguyen MTN, Saito N, Wagatsuma Y. The effect of comorbidities for the prognosis of community-acquired pneumonia: an epidemiologic study using a hospital surveillance in Japan. BMC Res Notes. 2019;12(1):817. doi:10.1186/s13104-019-4848-1.
• 24. Williamson DR, Lesur O, Tétrault JP, Nault V, Pilon D. Thrombocytopenia in the critically ill: prevalence, incidence, risk factors, and clinical outcomes La thrombocytopénie chez les personnes gravement malades: prévalence, incidence, facteurs de risque et pronostics cliniques. Can J Anesth/J Can Anesth. 2013;60(7):641-51.
• 25. Kushnir M, Cohen HW, Billett HH. Persistent neutrophilia is a marker for an increased risk of venous thrombosis. J Thromb Thrombolysis. 2016;42(4):545-51.
• 26. Lin Y, Dai W, Chen Y, He X, Xu Y. Neutrophil-to-platelet ratio predicts mortality following percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Front Physiol. 2022;13:1011048.
• 27. Akan OY, Bilgir O. Effects of neutrophil/monocyte, neutrophil/lymphocyte, neutrophil/platelet ratios and c-reactive protein levels on the mortality and intensive care need of the patients diagnosed with Covid-19. Eurasian J Med Investigation. 2021;5(1):21–6.