| Background and ObjectiveIn Clinically,Community acquired pneumonia(CAP)was a common process of pulmonary inflammation.Assessment of disease severity in patients with CAP could effectively guide their treatment options and predict their prognosis.In additon to clinical scoring systems and clinical symptoms and signs,there were a variety of tools available to evaluate the severity of CAP.The presence of biomarkers was related to the extent to which a patient's disease progresses,making it a potentially useful diagnostic tool.The decreased of platelet count was a recognized marker of poor prognosis in patients with pneumonia.However,some studies had found that pneumonia sometimes lead to increased in platelet count.Invasion of foreign pathogens can lead to disturbances in the body's immune functions,which in turn could lead to a decline in the body's lymphocyte count.Platelet to lymphocyte ratio(PLR)levels could be varied in response to various immune inflammatory responses throughout the body,and were simple and inexpensive to measure in clinically.However,In domestic and foreign,the current research on PLR mainly focuses on various malignant tumors,type 2 diabetic nephropathy,acute myocardial infarction,chronic hepatitis B and other diseases,et al,and there were few studies in CAP.This study was designed to investigate the predictive value of PLR for disease severity and prognosis in patients with CAP.Materials and MethodsAccording to?Guidelines for the diagnosis and treatment of adult community acquired pneumonia(2016 edition)?,we retrospectively selected 142 patients with CAP who hospitalized in Respiratory Medicine in The Second Affiliated Hospital of Zhengzhou University from Janunary 2013 to March 2018.We colleted basic situation(age,gender and underlying diseases,etc.);clinical signs and test result[body temperature at admission,24-hour secretion traits,gas exchange index,blood culture results,sputum culture results,chest X-ray,The first blood routine(white blood cell count(WBC),neutrophil counts,platelet counts),procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6];PLR and neutrophil to lymphocyte ratio(NLR)levels were calculated in both groups;outcomes.According to the median of PLR,it was divided into PLR?163 group and PLR<163 group.We compared PCT,NLR,WBC,CRP and IL-6 levels in the two groups.According to the Clinical Lung Infection Score(CPIS),the two groups of patients were divided into CPIS ? 6 and CPIS > 6 groups.We compared PLR,PCT,NLR,WBC,CRP and IL-6 levels in the two groups.We analyzed the correlation between PLR and CPIS scores,NLR,IL-6,WBC,PCT,CRP by Spearman Rank Correlation Analysis.We analyzed PLR and various inflammatory markers to predictive the prognosis of patients with CAP by plotting ROC curve.ResultsAccording to the CPIS,the patients were divided into CPIS?6 and CPIS>6.There were 71 patients in the CPIS?6 group,including 43 males and 28 females.The mean age of the CPIS?6 group was(58.51±18.43)years(between 18-90 years).The patients in the CPIS?6 group combined with basic disease types,including 15 cases of hypertension,14 cases of coronary heart disease,8 cases of diabetes,13 cases of other respiratory diseases.There were 71 patients in the CPIS>6 group,including 44 males and 27 females.The mean age of the CPIS>6 group was(57.90±17.83)years(between 18-87 years).The patients in the CPIS>6 group combined with basic disease types,including 18 cases of hypertension,13 cases of coronary heart disease,6 cases of diabetes,11 cases of other respiratory diseases.The patients in the CPIS?6 group had a significantly lower PLR value compared to the patients in the CPIS>6 group(141.65±58.34 vs.258.28±163.69;t=5.655,P<0.001).The patients in the CPIS?6 group had a significantly lower WBC value compared to the patients in the CPIS>6 group(Z=2.098,P<0.001).The patients in the CPIS?6 group had a significantly lower NLR value compared to the patients in the CPIS>6 group(Z=3.357,P<0.001).The patients in the CPIS?6 group had a significantly lower CRP value compared to the patients in the CPIS>6 group(Z=3.493,P<0.001).The patients in the CPIS?6 group had a significantly lower PCT value compared to the patients in the CPIS>6 group(Z=3.692,P<0.001).The patients in the CPIS?6 group had a significantly lower IL-6 value compared to the patients in the CPIS>6 group(Z=3.105,P<0.001).According to the median PLR value,the patients were divided into PLR?163 and PLR>163.There were 71 patients in the PLR?163 group,including 42 males and 29 females.The mean age of the PLR?163 group was(60.72±17.97)years(between 21-90 years).The patients in the PLR?163 group combined with basic disease types,including 16 cases of hypertension,12 cases of coronary heart disease,6 cases of diabetes,10 cases of other respiratory diseases.There were 71 patients in the PLR>163 group,including 45 males and 26 females.The mean age of the PLR>163 group was(55.69±17.95)years(between 18-87 years).The patients in the PLR>163 group combined with basic disease types,including 17 cases of hypertension,8 cases of diabetes,15 cases of coronary heart disease,14 cases of other respiratory diseases.The patients in the PLR?163 group had a significantly lower NLR value compared to the patients in the PLR>163 group(Z=5.267,P<0.001).The patients in the PLR?163 group had a significantly lower CRP value compared to the patients in the PLR>163 group(Z=4.842,P<0.001).The patients in the PLR?163 group had a significantly lower PCT value compared to the patients in the PLR>163 group(Z=5.553,P<0.001).The patients in the PLR?163 group had a significantly lower IL-6 value compared to the patients in the PLR>163 group(Z=5.312,P<0.001).There had no significantly in WBC between patients with the PLR?163 and PLR>163 group(Z=1.632,P>0.05).PLR is positively correlated with CPIS score,NLR,IL-6,PCT and CRP(r=0.491,P<0.001;r=0.488,P<0.001;r=0.490,P<0.001;r=0.489,P<0.001;r=0.415,P<0.001).There were no correlation between PLR and WBC(r=0.085,P=0.313).Within 28 days after admission,there were 5 death patients.CPIS score,NLR,CRP,PLR,IL-6,PCT predicted the area under the ROC curve of 28 days of CAP patients to be 0.924?0.843?0.819?0.816?0.793?0.781(P < 0.05).WBC predicted the area under the ROC curve of 28 days of CAP patients to be 0.585(P>0.05).Conclusions1.PLR is positively correlated with some indicators of inflammation.2.PLR can be used to evaluate the severity of CAP patients.3.PLR can be used as a predictor of the prognosis of CAP patients. |
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