| Objective: Explore neutrophil-to-lymphocyte ratio(NLR),red cell distribution width(RDW)value to evaluate the prognosis of patients with community-acquired pneumonia,and determine the best cutoff value,and further discussion on the two skills in the incremental effect of CURB-65 score on CAP prognosis was further studied,and on this basis to seek to establish an improved simple emergency risk score.Methods:Using the hospital information system and case management system database,retrospective case-control study was conducted to collect the clinical data of CAP patients who visited the department of respiratory medicine and intensive care unit of the second hospital of Hebei medical university from January to December 2018.According to the results of treatment outcome in patients with divided into death and survival groups,collecting the patients admitted to hospital general situation(age,gender,whether with basic disease,clinical manifestation,laboratory examination(white blood cell count(WBC),lymphocyte count(LBC),neutrophil counts(NBC),RDW,c-reactive protein(CRP)),and calculate the NLR(NBC/LBC),and the length of time,such as data,analysis and comparison of the variable difference between death and survival groups,and on the basis of whether line endotracheal intubation,whether ICU admission and CURB-65 score,respectively(intubation and non-intubation group,ICU admission and non-ICU admission,high-risk groups(CURB-65 score 0 to 2 points)and low risk group(CURB-65 score 3 to 5 points)),compare the NLR,RDW whether there is difference between the groups,and analyzed the correlation between NLR,RDW and CURB-65 score,pneumonia severity score(PSI).The prognostic value of NLR and RDW for CAP inpatients was statistically analyzed,and determined the cutoff value.According to the logistic multivariate regression beta definitions of the various index score,establish N-CURB-65 scoring system.The incremental effect of NLR and RDW on CURB-65 score was observed.Results:A total of 164 cases including 107 males and 57 females were included in this study.The average age(60.07±19.12)was 18 to 88 years.The days of hospitalization(14.04±8.21)ranged from 1 to 60 d.There were 24 cases of death and 140 cases of survival.The NLR of the death group was statistically different from that of the survival group(21.79±12.99 vs 6.95±13.33,P<0.05).There was a statistically significant difference in RDW between the death group and the survival group(51.66±6.63 vs 43.26±5.45,P<0.05).Moreover,the RDW and NLR values of patients with endotracheal intubation and those admitted to ICU were significantly higher than those without endotracheal intubation and those admitted to ICU.There was a statistically significant difference in NLR between the low-risk group and the high-risk group(8.20±15.97 vs 18.27±9.19,P<0.05).There was a statistically significant difference in RDW between the low-risk group and the high-risk group(43.78±5.88 vs 51.47±6.86,P<0.05).The correlation coefficient r=0.419 between NLR and CURB-65 was foundby pearman correlation analysis,P<0.01.Correlation coefficient with PSI score r=0.441,P<0.01.The correlation coefficient between RDW and CURB-65 socre was r=0.297,P<0.01.The correlation coefficient r with PSI score was 0.371,P<0.01.There was a significant positive correlation between RDW and CURB-65 scores at PSI and NLR and CURB-65 scores at PSI.The AUC of CRP was 0.79,the cutoff value was 14.3,the sensitivity was 95.8%,and the specificity was 52.9%.The AUC of WBC was 0.78 and cutoff value was 15.6,sensitivity was 50.0% and specificity was 96.4%.The AUC and cutoff value of the CURB-65 score was 0.88 and 1.The sensitivity and specificity were 83.3% and 87.1%.The AUC of PSI score was 0.95,the cutoff value was 94,the sensitivity was 95.8%,and the specificity was 92.9%.The AUC and cutoff values of NLR were 0.89 and 7.13 respectively,with a sensitivity of 91.7% and a specificity of 79.3%.The AUC of RDW was 0.87,the cutoff value was 45.6,the sensitivity was 83.3%,and the specificity was 80.7%.CURB-65 had a statistically significant difference in AUC compared with PSI(0.881vs0.951,Z=2.064,95%CI 0.0035-0.136,P<0.05).On the basis of the cutoff values of the NLR,RDW,and CURB-65 scores,the continuous variables were changed to binary variables(greater than cutoff value,denoted as 2;less than cutoff value,denoted as 1).Logistic multi element regression analysis showed that NLR(>7.13)(β=2.41,OR=11.124,95%CI 0.015-0.526),RDW(>45.6fl)(β=2.89,OR=18.181,95%CI 0.011-0.288),CURB-65 score(>1 points)(β=3.38,OR=29.413,95%CI 0.007-0.172)were independent risk factors for CAP deaths(P<0.05).The NLR>7.13 was 2,3 and 3 on the basis of NLR>7.13,RDW>45.6fl and CURB-65 score >1 points.The optimal cutoff value was 3.The sensitivity was 95.83%,and the specificity was 87.14%.The AUC of N-CURB-65 was not statistically different from that of PSI(0.96 vs 0.95,Z=0.649,95%CI 0.0261-0.0520,P>0.05),the AUC of n-curb-65 was statistically different from that of curb-65(0.96 vs 0.88,Z=2.009,95%CI 0.0020-0.163,P<0.05),and the AUC of N-CURB-65 was statistically different from that of NLR(0.96vs0.89,P<0.05).The N-CURB-65 score was statistically different from the RDW AUC(0.96vs0.87,Z=2.599,95%CI 0.0243-0.174,P<0.05).Spearman correlation analysis showed that the correlation coefficient r=0.566 between N-CURB-65 score and PSI score,P<0.01,the correlation was statistically significant.Conclusion:1.NLR and RDW were independent risk factors for hospital death in CAP group.Meanwhile,NLR and RDW in the endotracheal intubation group and the ICU admition group were significantly higher than those in the non-endotracheal intubation group and the non-ICU admition group.2.The CURB-65 score was better than the PSI score at predicting the CURB-65 mortality.3.The NLR and RDW had an incremental effect on the CURB-65 score on the prediction of hospital death at the CAP.CURB65 and NLR were combined with RDW to establish the N-CURB-65 score that is better than the original CURB-65 score,NLR and RDW.N-CURB-65 score and PSI score has good correlation,can be used to evaluate CAP the prognosis of patients with emergency. |
PDF Full Text Request