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The ratio of neutrophil-to-lymphocyte and platelet-to-lymphocyte and association with mortality in community-acquired pneumonia: a derivation-validation cohort study

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Abstract

Rationale

The ratio of neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and platelet-to-lymphocyte (PLR) are biomarkers that have shown potential for predicting mortality in several diseases. For patients hospitalized with community-acquired pneumonia (CAP), the prognostic capabilities of these biomarkers are unknown.

Objective

Investigate whether NLR, MLR or PLR were associated with 90-day mortality in CAP. Further, investigate whether the prediction rule CURB-65 could be improved by adding these biomarkers.

Methods

A derivation-validation study using a Danish multicentre retrospective cohort as the derivation cohort (N = 831) and a European multicentre prospective cohort as the validation cohort (N = 2463). Associations between biomarkers and mortality were assessed using Cox proportional hazard models with adjustments for sex, CURB-65 and comorbidities. A cut-off value for biomarkers was determined using Youden’s J Statistics. The performance of CURB-65 with added biomarkers was evaluated using receiver-operating characteristics.

Results

In both cohorts increasing NLR and PLR were associated with 90-day mortality. In the derivation cohort, the hazard ratios for NLR and PLR were 1.016 (95% confidence interval (CI) 1.001–1.032, P = 0.038) and 1.001 (95% CI 1.000–1.001, P = 0.035), respectively. Adding these biomarkers to CURB-65 did not improve its performance.

Conclusions

NLR and PLR were associated with 90-day mortality in CAP, but did not improve CURB-65.

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Data availability

According to Danish legislation, data cannot be shared without a prior legally binding data processing agreement. Data is, therefore, generally not shared.

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Acknowledgements

The authors thank the doctors who saw and identified patients with CAP for their work dedicated to the Community Acquired Pneumonia Competence Network (CAPNETZ), the CAPNETZ study team involved in patient recruitment and sample and data handling, and the patients included in the CAPNETZ study. Members of the CAPNETZ study group except the authors: Dreher M, Cornelissen C, Knüppel W, Stolz D, Suttorp N, Creutz P, Bauer T, Sabha T, Pankow W, Thiemig D, Lies A, Hauptmeier B, Wehde D, Prediger M, Schmager S, Kolditz M, Schulte-Hubbert B, Langner S, Höffken G, Ewig S, Barten G, Abrahamczik M, Naim J, Krôner W, Welte T, Illig T, Klopp N, Kroegel C, Pletz M, Happe J, Frosinski J, WinningJ, Moeser A, Dalhoff K, Dageförde K, Franzen K, Hyzy F, Schmieg H, Parschke P, Thiemann P, Ahrens J, Hardel T, Drijkoningen J, Braeken D, Buschmann H, Kröning R, Schaberg T, Hering I, Schütte H, Kropf-Sanchen C, Illmann T, Wallner M, Burghuber O, Rainer G. The authors would also like to thank the Pneumonia Research Group – Nordsjællands Hospital including research nurse Gudrun Kaldran.

Funding

The study was supported by a research Grant from Nordsjællands Hospital. CAPNETZ was founded by a Bundesministerium für Bildung und Forschung grant (number 01KI07145 2001–2011). The funding body did not play a role in the design of the study or collection, analysis, or interpretation of data or writing the manuscript.

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Authors and Affiliations

  1. Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark

    Christian Cosmus Enersen, Gertrud Baunbæk Egelund, Pelle Trier Petersen, Stine Andersen, Birgitte Lindegaard & Andreas Vestergaard Jensen

  2. Medical Department O, Herlev and Gentofte Hospital, Copenhagen, Denmark

    Pernille Ravn

  3. CAPNETZ Stiftung, Hannover, Germany

    Gernot Rohde

  4. Department of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt/Main, Germany

    Gernot Rohde

  5. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Birgitte Lindegaard

Authors
  1. Christian Cosmus Enersen
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  2. Gertrud Baunbæk Egelund
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  4. Stine Andersen
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  8. Andreas Vestergaard Jensen
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Contributions

All authors contributed to the study design. GBE, PTT, SA, PR, GR and AVJ participated in the construction of both cohorts. CCE and AVJ performed the statistically analysis. CCE, GBE, BL and AVJ drafted the main manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Andreas Vestergaard Jensen.

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The authors declare no competing interests.

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Enersen, C.C., Egelund, G.B., Petersen, P.T. et al. The ratio of neutrophil-to-lymphocyte and platelet-to-lymphocyte and association with mortality in community-acquired pneumonia: a derivation-validation cohort study. Infection 51, 1339–1347 (2023). https://doi.org/10.1007/s15010-023-01992-2

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