THE PLATELET-LYMPHOCYTE RATIO COMPARED WITH PNEUMONIA SEVERITY INDEX IN THE PREDICTION OF COMMUNITY-ACQUIRED PNEUMONIA

Öz

Objective: Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and a leading cause of mortality worldwide. The pneumonia severity index (PSI) is a clinical prediction score for determining short-term mortality and morbidity in patients with community-acquired pneumonia. The usefulness of rapid biochemical tests in predicting the severity of pneumonia have been investigated. Platelet-lymphocyte ratio (PLR) have been proposed as indicators of systemic inflammation and infection. The aim of this study was to investigate the predictive value of PLR levels and its association with PSI in patients with CAP in the emergency department.

Material and Method: This prospective case-control study included 78 patients admitted with CAP and 78 control patients. The PLR mean levels were compared between the study and control group. PSI were calculated and C-reactive protein (CRP) were measured. Correlation analyses were performed to investigate the association of PLR levels with CRP, PSI and hospitalization.

Results:  PLR levels were significantly higher in the study group compared to the control group (p <0.001).The PLR level of 140,5 had sensitivity of 70.5% and specificity of 82.1% and was positively correlated with PSI, CRP and hospitalization (r = 0.333; p= 0.003, r = 0.478; p <0.001, r=0.386; p<0.001). PLR levels were significantly higher in the inpatients subgroup compared to the outpatients subgroup (p= 0,001).

Conclusion: PLR levels significantly increased and positively correlated with PSI, CRP and hospitalization in adult patients presenting with CAP. PLR may be considered as a predictive biomarker of CAP.

Anahtar Kelimeler

• Pneumonia severity index,platelet-lymphocyte ratio,C-reactive protein,community acquired pneumonia

Toplumda gelişen pnömoninin öngörülmesinde trombosit-lenfosit oranı ve pnömoni ağırlık skorunun karşılaştırılması

Öz

Amaç: Toplumda gelişen pnömoni (TGP), hastaneye yatışın sık nedenidir ve dünya çapında önde gelen ölüm nedenidir. Pnömoni ağırlık skoru (PAS), TGP hastalarında kısa süreli mortaliteyi ve morbiditeyi belirlemek için kullanılan bir klinik tahmin skorudur. Pnömoni ağırlığını belirlemek için hızlı biyokimyasal tetkiklere yönelik çalışmalar yapılmaktadır. Trombosit-lenfosit oranı (TLO) sistemik inflamasyon ve enfeksiyonun göstergesi olarak önerilmiştir. Bu çalışmanın amacı acil serviste TGP'li hastalarda TLO düzeylerinin prediktif değerini ve PAS ile ilişkisini araştırmaktır.

Gereç ve Yöntem: Bu prospektif vaka kontrol çalışmasında 78 TGP ile başvuran hasta ve 78 kontrol olgusu yer almıştır. Ortalama TLO düzeyleri çalışma ve kontrol grubu arasında karşılaştırıldı. PAS'ları hesaplandı ve C-reaktif protein düzeyleri (CRP) ölçüldü. TLO düzeylerinin CRP, PAS ve hastaneye yatış ile ilişkisini araştırmak için korelasyon analizleri yapıldı.

Bulgular: Çalışma grubunda TLO düzeyleri kontrol grubuna göre anlamlı yüksekti (p <0,001). TLO düzeyi 140,5 için %70.5 duyarlılık ve %82.1 özgüllük saptandı. PAS, CRP ve hastaneye yatış ile pozitif korelasyon gösterdi (r = 0,333; p= 0,003, r = 0,478; p <0,001, r=0,386; p<0,001). TLO düzeyleri yatış verilen hasta alt grubunda ayaktan tedavi edilen alt grupla karşılaştırıldığında istatistiksel olarak yüksekti (p= 0,001).

Sonuç: TGP ile başvuran erişkin hastalarda kan TLO düzeyleri anlamlı olarak artmış ve PAS, CRP ve hastaneye yatış ile pozitif korelasyon göstermiştir. TLO, TGP hastalığı için prediktif bir biyobelirteç olarak düşünülebilir.

Anahtar Kelimeler

• Pnömoni ağırlık skoru,trombosit-lenfosit oranı,C-reaktif protein,toplumda gelişen pnömoni

Kaynakça

1. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adults. Am Fam Physician 2011;83:1299-1306.
2. Pinner RW, Teutsch SM, Simonsen L, Klug LA, Graber JM, Clarke MJ, et al. Trends in infectious diseases mortality in the United States. JAMA. 1996;275:189-93.
3. Chalmers JD, Mandal P, Singanayagam A, Akram AR, Choudhury G, Short PM, et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med 2011; 379:1409-1420.
4. Colice GL, Morley MA, Asche C, Birnbaum HG. Treatment costs of community-acquired pneumonia in an employed population. Chest 2004;125:2140-2145.
5. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.
6. Ewig S, Torres A, Woodhead M. Assessment of pneumonia severity: a European perspective. Eur Respir J 2006;27:6-8.
7. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-82.
8. Garcia Vazquez E, Martinez JA, Mensa J, Sanchez F, Marcos MA, de Roux A et al. C-reactive protein levels in community-acquired pneumonia. Eur Respir J 2003;21:702-705.

9. Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005;26:1138-1180
10. Toprak C, Tabakci MM, Simsek Z, Arslantas U, Durmus HI, Ocal L et al. Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. Postepy Kardiol Interwencyjnej 2015;11:288-297.
11. Koh CH, Bhoo-Pathy N, Ng KL, Jabir RS, Tan GH, See MH, et al. Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer. Br J Cancer 2015;113:150-158.
12. Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Med J 2017;118:513-516.
13. Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol 2012;23:265-273.
14. Thiem U, Niklaus D, Sehlhoff B, Stückle C, Heppner HJ, Endres HG, Pientka L. C-reactive protein, severity of pneumonia and mortality in elderly, hospitalized patients with community-acquired pneumonia. Age Ageing 2009;38:693–697.
15. Bruns AH, Oosterheert JJ, Hak E, and Hoepelman AI, Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 2008;32:726–732.
16. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003;111:1805-1812.
17. Epstein F. Acute phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340:448-454.
18. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Melot C et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest 2003;123:2043-2049.
19. De Jager CP, Wever PC, Gemen EF, Kusters R, van Gageldonk-Lafeber AB, van der Poll T, Laheij RJ, et al. The neutrophil-lymphocyte count ratio in patients with community acquired pneumonia. PLoS One 2012;7: e45561.
20. Krüger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008;31:349-355.
21. Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008;121:219–225.
22. Falk G, Fahey T. C-reactive protein and community-acquired pneumonia in ambulatory care: systematic review of diagnostic accuracy studies. Fam Pract 2009;26:10-21.
23. Engel MF, Paling FP, Hoepelman AI, van der Meer V, Oosterheert JJ. Evaluating the evidence for the implementation of C-reactive protein measurement in adult patients with suspected lower respiratory tract infection in primary care: a systematic review. Fam Pract 2012;29:383-93.
24. Marrie TJ. Community-acquired pneumonia. Clin Infect Dis 1994;18:501-513.