The Clincial Value Of NLR And RDW In Assessing The Severity And Prognosis Of Community-acquired Pneumonia In Adults

Objective:To observe the levels of neutrophil-lymphocyte ratio(NLR)and red blood cell distribution width(RDW)in community-acquired pneumonia(CAP)with different degrees of severity,in order to study the value of NLR and RDW in assessing the severity and prognosis of CAP in adults.Method: Collect 294 patients diagnosed with community-acquired pneumonia in the respiratory ward and intensive care unit(ICU)of the Second Hospital of Tianjin Medical University from January 2017 to June 2019.Collect gender,smoking history and age of them.According to CURB-65,they were divided into low-risk group(0-1points),middle-risk group(2points)and high-risk group(3-5points).The levels of white blood cells(WBC),neutrophils(NEU),lymphocytes(LYM),neutrophil-lymphocyte ratio(NLR),RDW,platelet(PLT),platelet-lymphocyte ratio(PLR),c-reactive protein to albumin ratio(CAR),hemoglobin(Hb),c-reactive protein(CRP),D-Dimer and fibrinogen(FIB)in different groups of patients were record to compare the differences within groups and analyze the correlation between CURB-65 score and the above indicators.Analyze the correlation of NLR,RDW with WBC,NEU and CRP.Collect and record the patient’s outcome within 30 days of admission,divided into the survival group and the death group,to compare the gender,smoking history,age and WBC,NEU,LYM,NLR,RDW,CAR,D-Dimer of the two groups.Draw the work of receiver operating characteristic curve to analyze the clinical value of WBC,NEU,LYM,NLR,RDW,D-Dimer,CURB-65 in predicting the death of patients within 30 days.Result:1.There were 294 eligible patients with CAP.According to CURB-65,they were divided into low-risk group(n=117),middle-risk group(n=75)and high-risk group(n=102).There was no statistical difference in the gender and smoking history of patients in the three groups.As the CURB-65 score increased,the age of patients increased(P<0.01).2.In the low-risk group,middle-risk group and high-risk group,the sicker the patient,the higher the levels of WBC,NEU,NLR,RDW,PLR,CRP and D-Dimer(P<0.05),and the lower the levels of LYM,PLT and Hb.RDW is within the normal reference range.3.CURB-65 score was positively correlated with WBC,NEU,NLR,RDW,PLR,CRP and D-Dimer.It was negatively correlated with LYM,PLT and Hb.No correlation with CAR or FIB was found(P>0.05).NLR was positively correlated with WBC,NEU and CRP(r=0.621,0.376,0.522,p < 0.01).There was a positive correlation between RDW and NEU(r=0.120,p < 0.05),but there was no correlation between RDW and WBC and CRP(P>0.05).4.Collect and record the patient’s outcome within 30 days of admission,divided into survival group(n=238)and death group(n=56).There was no statistically significant difference in gender and smoking history between the two groups(P >0.05).Patients in the death group(76.50±13.725years)were older than those in the survival group(71.73±16.505years)(P < 0.05).In the survival group,WBC,NEU,NLR,RDW and D-Dimer were lower than those in the death group,with statistically significant differences(P < 0.01).There was no significant difference in CAR(p >0.05).5.The areas under the ROC curve predicted by WBC,NEU,LYM,NLR,RDW,D-Dimer,CURB-65 for 30-day death in patients with CAP were 0.676,0.711,0736,0.768,0.693,0.806,and 0.782.NLR was better than WBC,NEU and LYM in predicting 30-day death in patients with CAP.Conclusion:NLR has clinical value in assessing the severity and prognosis of CAP in adults.The more severe the disease,the worse the prognosis,the higher the NLR.There is no significant correlation between RDW and the severity and prognosis of CAP in adults.