Journal of Anesthesia and Intensive Care

Volume 2, Issue 3 (2021)

Research Article - Open Access
Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR) and Red Cell Distribution Width (RDW) to Predict Outcome and Differentiate between Viral and Bacterial Pneumonia in the Intensive Care Unit: A Retrospective Study

Wing-Sze NG1*, Sin-Man Lam1, Wing-Wa Yan1, Anne Kit-Hung Leung1, Hoi-Ping Shum1

1 Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong Special Administrative Region, China

2 Department of Intensive Care, Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong Special Administrative Region, China

*Corresponding Author:
Wing-Sze NG
MBBS, MRCP (UK), PDipID (HK), FHKCP, Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong Special Administrative Region, China.
Tel: 852-64806646, 852-25956111; Fax: 852-25956499; E-mail: nws898@ha.org.hk

Received date: October 30, 2021; Accepted date: November 23, 2021; Published date: November 30, 2021

Citation: Wing-Sze NG, Lam SM, Yan WW, Leung KH, Shum HP. Neutrophil-To-Lymphocyte Ratio (NLR), Monocyte-To-Lymphocyte Ratio (MLR), Platelet-To-Lymphocyte Ratio (PLR) and Red Cell Distribution Width (RDW) to Predict Outcome and Differentiate between Viral and Bacterial Pneumonia in the Intensive Care Unit: A Retrospective Study. J Anest Inten Care. 2021;2(3):60-72.

Copyright: © 2021 Wing-Sze NG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: Neutrophil-to-Lymphocyte ratio (NLR), Monocyte-to-Lymphocyte ratio (MLR), Platelet-to- Lymphocyte Ratio (PLR), and Red Cell Distribution Width (RDW) are emerging biomarkers to predict outcome in general ward patients. However, their role in the prognostication of critically ill patients with pneumonia is unclear.

Material and Methods: 216 adult patients were enrolled over 2 years. They were classified into viral and bacterial pneumonia groups, represented by influenza A virus and Streptococcus pneumonia, respectively. Demographics, outcomes, and laboratory parameters were analyzed. The prognostic power of blood parameters was determined by their respective area under the receiver operating characteristic curve (AUROC). Their performance was compared with the APACHE IV score. Discriminant ability in differentiating viral and bacterial aetiologies was studied.

Results: Viral and bacterial pneumonia were identified in 111 and 105 patients, respectively. In predicting hospital mortality, the APACHE IV score was the best prognostic score compared with all the studied blood parameters (AUC 0.769, 95% CI 0.705-0.833). In classification tree analysis, the most significant predictor of hospital mortality was the APACHE IV score (adjusted P=0.000, χ2 = 35.591). Mechanical ventilation was associated with higher hospital mortality in those patients with low APACHE IV score <=70 (adjusted P=0.014, χ2 = 5.999). In patients with high APACHE IV score >90, age (>78, adjusted P=0.007, χ2 = 11.221) and thrombocytopenia (platelet count <=128, adjusted P=0.004, χ2 = 12.316) were predictive of higher hospital mortality.

Conclusion: Novel inflammatory biomarkers were not comparable to the APACHE IV score in predicting hospital mortality. In differentiation between viral and bacterial pneumonia, there is no ideal biomarker.

Keywords

Neutrophil-to-lymphocyte ratio; Mortality; Intensive care unit; Viral pneumonia; Bacterial pneumonia