The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia

Cornelis P.C. de Jager, Peter C. Wever, Eugenie F.A. Gemen, Ron Kusters, Arianne B. van Gageldonk-Lafeber, Tom van der Poll, Robert J.F. Laheij

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    Abstract

    Study Objective: The neutrophil-lymphocyte count ratio (NLCR) has been identified as a predictor of bacteremia in medical emergencies. The aim of this study was to investigate the value of the NLCR in patients with community-acquired pneumonia (CAP).

    Methods and Results: Consecutive adult patients were prospectively studied. Pneumonia severity (CURB-65 score), clinical characteristics, complications and outcomes were related to the NLCR and compared with C-reactive protein (CRP), neutrophil count, white blood cell (WBC) count. The study cohort consisted of 395 patients diagnosed with CAP. The mean age of the patients was 63.4±16.0 years. 87.6% (346/395) of the patients required hospital admission, 7.8% (31/395) patients were admitted to the Intensive Care Unit (ICU) and 5.8% (23/395) patients of the study cohort died. The NLCR was increased in all patients, predicted adverse medical outcome and consistently increased as the CURB-65 score advanced. NLCR levels (mean ± SD) were significantly higher in non-survivors (23.3±16.8) than in survivors (13.0±11.4). The receiver-operating characteristic (ROC) curve for NLCR predicting mortality showed an area under the curve (AUC) of 0.701. This was better than the AUC for the neutrophil count, WBC count, lymphocyte count and CRP level (0.681, 0.672, 0.630 and 0.565, respectively).

    Conclusion: Admission NLCR at the emergency department predicts severity and outcome of CAP with a higher prognostic accuracy as compared with traditional infection markers.
    Original languageEnglish
    JournalPLoS ONE
    Volume7
    Issue number10
    DOIs
    Publication statusPublished - 1 Oct 2012

    Cite this

    de Jager, C. P. C., Wever, P. C., Gemen, E. F. A., Kusters, R., van Gageldonk-Lafeber, A. B., van der Poll, T., & Laheij, R. J. F. (2012). The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia. PLoS ONE, 7(10). https://doi.org/10.1371/journal.pone.0046561
    de Jager, Cornelis P.C. ; Wever, Peter C. ; Gemen, Eugenie F.A. ; Kusters, Ron ; van Gageldonk-Lafeber, Arianne B. ; van der Poll, Tom ; Laheij, Robert J.F. / The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia. In: PLoS ONE. 2012 ; Vol. 7, No. 10.
    @article{0038d0a3f7d742c2b22382c7a7cdf641,
    title = "The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia",
    abstract = "Study Objective: The neutrophil-lymphocyte count ratio (NLCR) has been identified as a predictor of bacteremia in medical emergencies. The aim of this study was to investigate the value of the NLCR in patients with community-acquired pneumonia (CAP).Methods and Results: Consecutive adult patients were prospectively studied. Pneumonia severity (CURB-65 score), clinical characteristics, complications and outcomes were related to the NLCR and compared with C-reactive protein (CRP), neutrophil count, white blood cell (WBC) count. The study cohort consisted of 395 patients diagnosed with CAP. The mean age of the patients was 63.4±16.0 years. 87.6{\%} (346/395) of the patients required hospital admission, 7.8{\%} (31/395) patients were admitted to the Intensive Care Unit (ICU) and 5.8{\%} (23/395) patients of the study cohort died. The NLCR was increased in all patients, predicted adverse medical outcome and consistently increased as the CURB-65 score advanced. NLCR levels (mean ± SD) were significantly higher in non-survivors (23.3±16.8) than in survivors (13.0±11.4). The receiver-operating characteristic (ROC) curve for NLCR predicting mortality showed an area under the curve (AUC) of 0.701. This was better than the AUC for the neutrophil count, WBC count, lymphocyte count and CRP level (0.681, 0.672, 0.630 and 0.565, respectively).Conclusion: Admission NLCR at the emergency department predicts severity and outcome of CAP with a higher prognostic accuracy as compared with traditional infection markers.",
    author = "{de Jager}, {Cornelis P.C.} and Wever, {Peter C.} and Gemen, {Eugenie F.A.} and Ron Kusters and {van Gageldonk-Lafeber}, {Arianne B.} and {van der Poll}, Tom and Laheij, {Robert J.F.}",
    year = "2012",
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    de Jager, CPC, Wever, PC, Gemen, EFA, Kusters, R, van Gageldonk-Lafeber, AB, van der Poll, T & Laheij, RJF 2012, 'The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia' PLoS ONE, vol. 7, no. 10. https://doi.org/10.1371/journal.pone.0046561

    The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia. / de Jager, Cornelis P.C.; Wever, Peter C.; Gemen, Eugenie F.A.; Kusters, Ron; van Gageldonk-Lafeber, Arianne B.; van der Poll, Tom; Laheij, Robert J.F.

    In: PLoS ONE, Vol. 7, No. 10, 01.10.2012.

    Research output: Contribution to journalArticleAcademicpeer-review

    TY - JOUR

    T1 - The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia

    AU - de Jager, Cornelis P.C.

    AU - Wever, Peter C.

    AU - Gemen, Eugenie F.A.

    AU - Kusters, Ron

    AU - van Gageldonk-Lafeber, Arianne B.

    AU - van der Poll, Tom

    AU - Laheij, Robert J.F.

    PY - 2012/10/1

    Y1 - 2012/10/1

    N2 - Study Objective: The neutrophil-lymphocyte count ratio (NLCR) has been identified as a predictor of bacteremia in medical emergencies. The aim of this study was to investigate the value of the NLCR in patients with community-acquired pneumonia (CAP).Methods and Results: Consecutive adult patients were prospectively studied. Pneumonia severity (CURB-65 score), clinical characteristics, complications and outcomes were related to the NLCR and compared with C-reactive protein (CRP), neutrophil count, white blood cell (WBC) count. The study cohort consisted of 395 patients diagnosed with CAP. The mean age of the patients was 63.4±16.0 years. 87.6% (346/395) of the patients required hospital admission, 7.8% (31/395) patients were admitted to the Intensive Care Unit (ICU) and 5.8% (23/395) patients of the study cohort died. The NLCR was increased in all patients, predicted adverse medical outcome and consistently increased as the CURB-65 score advanced. NLCR levels (mean ± SD) were significantly higher in non-survivors (23.3±16.8) than in survivors (13.0±11.4). The receiver-operating characteristic (ROC) curve for NLCR predicting mortality showed an area under the curve (AUC) of 0.701. This was better than the AUC for the neutrophil count, WBC count, lymphocyte count and CRP level (0.681, 0.672, 0.630 and 0.565, respectively).Conclusion: Admission NLCR at the emergency department predicts severity and outcome of CAP with a higher prognostic accuracy as compared with traditional infection markers.

    AB - Study Objective: The neutrophil-lymphocyte count ratio (NLCR) has been identified as a predictor of bacteremia in medical emergencies. The aim of this study was to investigate the value of the NLCR in patients with community-acquired pneumonia (CAP).Methods and Results: Consecutive adult patients were prospectively studied. Pneumonia severity (CURB-65 score), clinical characteristics, complications and outcomes were related to the NLCR and compared with C-reactive protein (CRP), neutrophil count, white blood cell (WBC) count. The study cohort consisted of 395 patients diagnosed with CAP. The mean age of the patients was 63.4±16.0 years. 87.6% (346/395) of the patients required hospital admission, 7.8% (31/395) patients were admitted to the Intensive Care Unit (ICU) and 5.8% (23/395) patients of the study cohort died. The NLCR was increased in all patients, predicted adverse medical outcome and consistently increased as the CURB-65 score advanced. NLCR levels (mean ± SD) were significantly higher in non-survivors (23.3±16.8) than in survivors (13.0±11.4). The receiver-operating characteristic (ROC) curve for NLCR predicting mortality showed an area under the curve (AUC) of 0.701. This was better than the AUC for the neutrophil count, WBC count, lymphocyte count and CRP level (0.681, 0.672, 0.630 and 0.565, respectively).Conclusion: Admission NLCR at the emergency department predicts severity and outcome of CAP with a higher prognostic accuracy as compared with traditional infection markers.

    U2 - 10.1371/journal.pone.0046561

    DO - 10.1371/journal.pone.0046561

    M3 - Article

    VL - 7

    JO - PLoS ONE

    JF - PLoS ONE

    SN - 1932-6203

    IS - 10

    ER -

    de Jager CPC, Wever PC, Gemen EFA, Kusters R, van Gageldonk-Lafeber AB, van der Poll T et al. The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia. PLoS ONE. 2012 Oct 1;7(10). https://doi.org/10.1371/journal.pone.0046561