Abstract
Background
Differentiating pneumonia from chronic heart failure (HF) in normothermic subjects
in the emergency department (ED) is significantly difficult.
Objective
This study aimed to evaluate the predictive value of the neutrophil-to-lymphocyte
ratio (NLR) in establishing the diagnosis of pneumonia in normothermic subjects with
chronic HF in the ED.
Methods
This study included 523 adult dyspneic patients with chronic HF presenting in the
ED. We categorized the selected patients into the nonpneumonia group (NPG) and the
pneumonia group (PG), and the patients' serum white blood cell (WBC), neutrophil,
and lymphocyte counts, NLR, and C-reactive protein (CRP) levels were measured upon
arrival in the ED. Subsequently, we compared their predictive powers after performing
a propensity score-matching (PSM) analysis.
Results
The PG included 120 (22.9%) patients. After performing PSM, the mean NLR was significantly
higher in the PG than in the NPG group (p < 0.001). According to the receiver operating characteristic area under the curve
(AUC) analysis of inflammatory markers, the AUC of the NLR was significantly higher
than that of WBCs, neutrophils, lymphocytes, and CRP.
Conclusion
The predictive value of the NLR was significantly higher than that of WBCs, neutrophils,
lymphocytes, and CRP. Therefore, NLR may be a useful adjunctive marker to establish
the early diagnosis of pneumonia in normothermic patients with chronic HF in the ED.
Keywords
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References
- The limited reliability of physical signs for estimating hemodynamics in chronic heart failure.JAMA. 1989; 261: 884-888
- Regulation of adhesion molecules during human endotoxemia: no acute effects of aspirin.Am J Respir Crit Care Med. 1999; 159: 857-863
- Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit.Crit Care. 2010; 14: R192
- Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill.Bratisl Lek Listy. 2001; 102: 5-14
- Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure.Ann Emerg Med. 2006; 47: 13-18
- Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention.Am J Respir Crit Care Med. 2001; 163: 1730-1754
- Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality.Clin Infect Dis. 2017; 65: 1806-1812
- Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies.Ann Emerg Med. 2014; 64: 292-298
- Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure.Am J Cardiol. 2015; 115: 57-61
- Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure.Am J Cardiol. 2011; 107: 433-438
- Neutrophil to lymphocyte (N/L) and platelet to lymphocyte (P/L) ratios in differentiating acute heart failure from respiratory infection.Curr Vasc Pharmacol. 2017; 15: 477-481
- C-reactive protein to distinguish pneumonia from acute decompensated heart failure.Clin Biochem. 2009; 42: 1628-1634
- Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis.Gut. 2000; 46: 233-238
- C-reactive protein. A clinical marker in community-acquired pneumonia.Chest. 1995; 108: 1288-1291
- Failure to normalize lymphopenia following trauma is associated with increased mortality, independent of the leukocytosis pattern.Crit Care. 2012; 16: R12
- Differential lymphopenia-induced homeostatic proliferation for CD4+ and CD8+ T cells following septic injury.J Leukoc Biol. 2009; 85: 382-390
- Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome.Shock. 2002; 18: 487-494
- Bacteraemia prediction in emergency medical admissions: role of C reactive protein.J Clin Pathol. 2005; 58: 352-356
- Relation between lymphopenia and bacteraemia in UK adults with medical emergencies.J Clin Pathol. 2004; 57: 950-955
- Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: a prospective observational study.Mediators Inflamm. 2016; 2016: 8191254
- Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome.Am J Cardiol. 2008; 102: 653-657
- Neutrophil–lymphocyte ratio reflects hepatocellular carcinoma recurrence after liver transplantation via inflammatory microenvironment.J Hepatol. 2013; 58: 58-64
- Risk factors for community-acquired pneumonia in adults: a population-based case-control study.Eur Respir J. 1999; 13: 349-355
- The prognostic importance of lung function in patients admitted with heart failure.Eur J Heart Fail. 2010; 12: 685-691
- The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure.J Am Coll Cardiol. 2003; 42: 736-742
- Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial.Eur J Heart Fail. 2012; 14: 278-286
Article info
Publication history
Published online: March 20, 2020
Accepted:
January 9,
2020
Received in revised form:
December 23,
2019
Received:
August 1,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
