PULMONOLOGY / CLINICAL RESEARCH
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The aim of the study was to evaluate inflammatory markers (neutrophil to lymphocyte ratio [NLR], platelet to lymphocyte ratio [PLR], platelet to mean platelet volume [PLT/MPV], C-reactive protein [CRP], CRP/albumin) in hospitalized patients with bacterial community-acquired pneumonia (CAP) and to differentiate between Gram-positive and Gram-negative groups and between admission and discharge findings.

Material and methods:
A total of 170 adult patients hospitalized with bacterial CAP due to Gram-positive (n = 130) and Gram-negative (n = 40) pathogens were included in this retrospective study. Complete blood count (CBC) and inflammatory markers (NLR, PLR, platelet/MPV ratio, CRP, albumin) were recorded.

Results:
Gram-negative vs. Gram-positive pneumonia was associated with significantly higher likelihood of being hospitalized at the ICU (70.0% vs. 2.3%, p < 0.001), mortality (20.0% vs. 2.3%, p < 0.001) and sepsis (27.5% vs. 0.0%, p < 0.001). Neutrophil to lymphocyte ratio, PLR and PLT/MPV at admission or discharge showed no significant difference between study groups. A significant decrease in NLR (p < 0.001 and p = 0.026, respectively), CRP (p < 0.001 and p = 0.013, respectively) and CRP/albumin ratio (p = 0.021 and p = 0.037, respectively) was noted from admission to discharge in both groups.

Conclusions:
In conclusion, our findings in a retrospective cohort of hospitalized CAP patients revealed no significant role of NLR, PLR, PLT/MPV or CRP in differential diagnosis of Gram-negative versus Gram-positive etiology and thus no additional benefit of these markers in faster implementation of appropriate treatment in accordance with the Gram stain.
REFERENCES (31)
1.
Lim WS, Smith DL, Wise MP, et al.; British Thoracic Society. British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline: how they fit together. Thorax 2015; 70: 698-700.
 
2.
Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med 2014; 371: 1619-28.
 
3.
Remington LT, Sligl W. Community-acquired pneumonia. Curr Opin Pulm Med 2014; 20: 215-24.
 
4.
Bekdas M, Goksugur SB, Sarac EG, et al. Neutrophil/lymphocyte and C-reactive protein/mean platelet volume ratios in differentiating between viral and bacterial pneumonias and diagnosing early complications in children. Saudi Med J 2014; 35: 442-7.
 
5.
Yan ST, Sun LC, Lian R, et al. Diagnostic and predictive values of procalcitonin in bloodstream infections for nosocomial pneumonia. J Crit Care 2018; 44: 424-9.
 
6.
Anevlavis S, Petroglou N, Tzavaras A, et al. A prospective study of the diagnostic utility of sputum Gram stain in pneumonia. J Infect 2009; 59: 83-9.
 
7.
Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect 2011; 17: 1-59.
 
8.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43: 304-77.
 
9.
Broughton WA, Middleton III RM, Kirkpatrick MB, et al. Bronchoscopic protected specimen brush and bronchoalveolar lavage in the diagnosis of bacterial pneumonia. Infect Dis Clin North Am 1991; 5: 437-52.
 
10.
Reed WW, Byrd GS, Gates Jr RH, et al. Sputum Gram’s stain in community-acquired pneumococcal pneumonia: a meta-analysis. West J Med 1996; 165: 197-204.
 
11.
Leven M, Goosens H. Relevance of nucleic acid amplification techniques for diagnosis of respiratory tract infections in the clinical laboratory. Clin Microbiol Rev 1997; 10: 242-56.
 
12.
Boerner DF, Zwadyk P. The value of the sputum Gram’s stain in community-acquired pneumonia. J Am Med Assoc 1982; 247: 642-5.
 
13.
Kalin M, Lindberg AA, Tunewall G. Etiological diagnosis of bacterial pneumonia by Gram stain and quantitative culture of expectorates. Scand J Infect Dis 1983; 15: 153-60.
 
14.
Christ-Crain M, Muller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 2007; 30: 556-73.
 
15.
Schuetz P, Christ-Crain M, Muller B. Biomarkers to improve diagnostic and prognostic accuracy in systemic infections. Curr Opin Crit Care 2007; 13: 578-85.
 
16.
Kopterides P, Siempos, II, Tsangaris I, et al. Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med 2010; 38: 2229-41.
 
17.
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45-67.
 
18.
de Jager CP, Wever PC, Gemen EF, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One 2012; 7: e46561.
 
19.
de Jager CP, van Wijk PT, Mathoera RB, et al. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 2010; 14: 192.
 
20.
Martinez R, Menendez R, Reyes S, et al. Factors associated with inflammatory cytokine patterns in community- acquired pneumonia. Eur Respir J 2011; 37: 393-9.
 
21.
Chalupa P, Beran O, Herwald H, et al. Evaluation of potential biomarkers for the discrimination of bacterial and viral infections. Infection 2011; 39: 411-7.
 
22.
Adams NG. Diagnostic use of C-reactive protein in bacteraemic emergency department patients. Emerg Med Australas 2005; 17: 371-5.
 
23.
Yao C, Liu X, Tang Z. Prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for hospital mortality in patients with AECOPD. Int J Chron Obstruct Pulmon Dis 2017; 12: 2285-90.
 
24.
Curbelo J, Luquero Bueno S, et al. Inflammation biomarkers in blood as mortality predictors in community- acquired pneumonia admitted patients: importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio. PLoS One 2017; 12: e0173947.
 
25.
Yang T, Wan C, Wang H, et al. The prognostic and risk- stratified value of neutrophil–lymphocyte count ratio in Chinese patients with community-acquired pneumonia. Eur J Inflamm 2017; 15: 22-7.
 
26.
Karataş MB, Ipek G, Onuk T, et al. Assessment of prognostic value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with pulmonary embolism. Acta Cardiol Sin 2016; 32: 313-20.
 
27.
Welte T, Torres A, Nathwani D. Clinical and economic burden of community acquired pneumonia among adults in Europe. Thorax 2012; 67: 71-9.
 
28.
Amyes SG. Enterococci and streptococci. Int J Antimicrob Agents 2007; 29: 43-52.
 
29.
Pang F, Jia XQ, Zhao QG, et al. Factors associated to prevalence and treatment of carbapenem-resistant Enterobacteriaceae infections: a seven years retrospective study in three tertiary care hospitals. Ann Clin Microbiol Antimicrob 2018; 17: 13.
 
30.
MacGowan A, Macnaughton E. Antibiotic resistance. Medicine 2017; 45: 622-8.
 
31.
Ozyürek BA, Erturk A, Aydemir Y, et al. The approach to community-acquired pneumonia: a survey study. Eurasian J Pulmonol 2018; 20: 93-8.
 
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ISSN:1734-1922
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