Evaluation Of CURB-65 Combined With Neutrophil/Lymphocyte Ratio In Community-Acquired Pneumonia In Tibet

Objective: To investigate the role of neutrophil to lymphocyte ratio(NLR),CURB-65 score and pneumonia severity index(PSI)in the severity and prognosis of community acquired pneumonia(CAP)in Tibet,and to determine the optimal cutoff value.To further explore the value of CURB-65 score combined with NLR in evaluating the severity and prognosis of disease.Methods: A total of 226 patients with community-acquired pneumonia admitted to the Department of Respiratory and Critical Care Medicine,People’s Hospital of Tibet Autonomous Region from June 2021 to June 2022 were selected.The general clinical data(including age,gender,smoking and biofuel exposure history,hospitalization time,clinical manifestations,complications,etc.),blood routine(including neutrophils and lymphocytes),C-reactive protein,procalcitonin,biochemical and other test indicators within 24 hours of admission,mechanical ventilation and prognosis were collected.NLR,CURB-65 score and PSI were calculated.According to the Chinese adult community-acquired pneumonia diagnosis and treatment guidelines(2016 edition),189 cases were divided into non-severe group(CAP)and 37 cases of severe group(SCAP).According to the patient’s discharge outcome,they were divided into survival group 204 cases and death group(including automatic discharge)22 cases.The statistical differences of general conditions and inflammatory indexes between CAP/SCAP group and survival group/death group were compared by t test or chi-square test or U test.Multivariate Logistics regression was used to analyze the severity of the disease and the risk factors of prognosis.The correlation between PSI score and CURB-65 score combined with NLR was analyzed by spearman.The predictive value of NLR,CURB-65 score,NLR combined with CURB-65 score and PSI score for disease severity and death risk was analyzed by plotting the receiver operating characteristic curve.Results: For the clinical data: There were 189 cases in CAP group and 37 cases in SCAP group.The age,hospitalization time,mechanical ventilation,WBC,CRP,PCT,NLR,CURB-65 score and PSI score of SCAP group were higher than those of CAP group(p<0.05).There was no significant different in gender and smoking/biofuel exposure between the two groups.The incidence of kidney disease,tumor,heart failure and cerebrovascular disease in SCAP group was higher than that in CAP group(p<0.05).There was no significance in liver disease,hypertension and diabetes between the two groups.There were 204 cases in the survival groups and 22 cases in the death group.The age,mechanical ventilation,WBC,CRP,PCT,NLR,CURB-65 score and PSI score in the death group were higher than those in the survival group,and there was significant difference between the two groups(p<0.05).There was no significant different in hospitalization time,gender and smoking/biofuel exposure.The incidence of liver disease,kidney disease and cerebrovascular disease in the death group was higher than that in the survival group(p<0.05).There was no significance in tumor,heart failure,hypertension and diabetes between the two groups.Multivariate logistic regression analysis of factors affecting severity and prognosis:PCT,NLR,CURB-65 score and PSI scores are independent risk factors for severe pneumonia patients(p<0.05),NLR and PSI score are independent risk factors for death(p<0.05).The predictive value of each index for the severity and prognosis of CAP patients: In CAP/SCAP group,the AUC of PCT,NLR,CURB-65 and PSI were0.893,0.921,0.866 and 0.936,respectively.When the PCT cutoff value was 0.8,the sensitivity was 85.2% and the specificity was 88.4%.When the NLR cutoff value was7.69,the sensitivity was 91.9% and the specificity was 85.2%.When the cutoff value of CURB-65 is greater than 1,the sensitivity was 91.9% and the specificity was63.0%.When the PSI cutoff value was 111.5,the sensitivity was 86.5% and the specificity was 88.4%.The AUC of CURB-65 score combined with NLR in predicting SCAP was 0.940,the sensitivity was 94.6% and the specificity was 86.2%.There was a significant correlation between CURB-65 combined with NLR and PSI score in evaluating the severity of disease(p<0.05).In survival group/death group,the AUC of NLR,CURB-65 and PSI were 0.916,0.861 and 0.961,respectively.When the NLR cutoff value was 7.855,the sensitivity was 90.9% and the specificity was 80.4%.When the cutoff value of CURB-65 is greater than 2,the sensitivity was 72.7% and the specificity was 90.7%.When the PSI cutoff value was 119.5,the sensitivity was90.9% and the specificity was 92.2%.The AUC of CURB-65 score combined with NLR in predicting death was 0.945,the sensitivity was 95.5% and the specificity was87.7%.There was a significant correlation between CURB-65 combined with NLR and PSI score in evaluating prognosis(p<0.05).Conclusion: NLR and PSI are independent risk factors for severe pneumonia and death.CURB-65 score is an independent risk factor for severe pneumonia.The PSI score has good predictive ability for CAP,but the evaluation index is cumbersome,time-consuming,and less clinically used.CURB-65 has poor predictive performance for CAP patients,and increasing NLR variables significantly improves the evaluation ability of CURB-65.The prediction of CURB-65 combined with NLR for severe pneumonia and death is significantly better than that of single index,and the sensitivity and specificity are good.The combination of the two and the PSI score can effectively judge the severity and prognosis of patients with CAP in Tibet,and the combination of the two and the PSI score have a significant correlation with the ability to evaluate the severity and prognosis of the disease.However,NLR combined with CURB-65 score is simple to operate,convenient to obtain parameters,and more convenient for clinical use.