Research Article
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Comparison of procalcitonin, C-reactive protein, white blood cell counts and hemogram subparameters in community acquired pneumonia patients

Year 2023, Volume: 4 Issue: 6, 672 - 677, 31.12.2023

Mustafa İlteriş Bardakçı Gülhan Ayhan Albayrak

https://doi.org/10.47582/jompac.1394077

Abstract

Aims: Pneumonia is a clinically and radiologically detected inflammation of the lungs. Most of the pneumonia patients are community-acquired pneumonia cases. Hemogram and C-reactive protein (CRP) are commonly used to support diagnosis and follow-up of treatment. Procalcitonin is less accessible and expensive. And the use of hemogram subparameters is not very common. The aim of this study was to research the relationship between procalcitonin, CRP, White Blood Cell count (WBC) and hemogram subparameters in patients with CAP and the efficacy of new hematologic rates in differential diagnosis.
Methods: Patients who were diagnosed with community acquired pneumonia by applying to the chest diseases outpatient clinic of our hospital were retrospectively analyzed. 67 patients who were clinically and radiologically diagnosed without noticing male or female were included in our study. Anamnesis data and co-morbidities of the cases were questioned. Procalcitonin, CRP and hemogram (platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) were calculated and WBC value was examined) were recorded. The obtained data were evaluated statistically and compared in terms of variables.
Results: The mean age of our patients was 57 (18-71) years; there were 41 (61.19%) female and 26 (38.81%) male patients. 36 (53.73%) of our patients had chronic diseases; 21 (31.34%) had heart disease, 23 (34.32%) had diabetes, and 6 (8.95%) had kidney failure. Patients; 48 (71.64%) procalcitonin, 56 (83.58%) CRP, 38 (56.71%) WBC, 52 (77.61%) NLR, 34 (50.74%) PLR and 38 (56.71%) MLR values were high. Procalcitonin, CRP and NLR values were significantly higher than other subparameters. The CRP and NLR values of patients with an additional chronic disease were higher than patients without co-morbidities. In the correlation analyses, there was a strong correlation between procalcitonin, CRP and NRL, but the correlation between the others was not significant. (p<0.001).
Conclusion: Our study shows NLR from hemogram subparameters can be used safely in CAP patients. Procalcitonin is expensive test for. Considering that Procalcitonin is not available in primary care family health centers and CRP is found in some family health centers, the calculated use of NLR will support the diagnosis. Using fewer examinations in secondary and tertiary health facilities is also valuable in terms of reducing health costs.

Keywords

Pneumonia NLR procalsitonin CRP

Ethical Statement

form yükledim

Supporting Institution

yok

References

  • Türk Toraks Derneği. Erişkinlerde toplumda gelişen pnömoniler tanı ve tedavi uzlaşı raporu. Buluş;2021.
  • Almiral J, Bolibar I,Vidal J, et al. Epidemiology of community acquired pneumonia in adults: apopulation –based study. Eur Respir J. 2000;15(4):757-763.
  • Theilacker C, Sprenger R, Leverkus F, et al. Population-based incidence and mortality of community-acquired pneumonia in Germany. PLoS One. 2021;16(6):e0253118.
  • T.C. Sağlık Bakanlığı, Refik Saydam Hıfzıssıhha Merkezi Başkanlığı Hıfzıssıhha Mektebi Müdürlüğü, Başkent Üniversitesi Ulusal Hastalık Yükü ve Maliyeti Etkinlik Projesi, 2004 (www.toraks.org.tr).
  • Wunderink RG. Community-acquired pneumonia. In: Cohen J, Powderly, Opal SM, eds. Infectious Diseases. 4th ed. Elsevier;2017:251-257.
  • Ramirez JA, Wiemken TL, Peyrani P, et al. Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality. Clin Infect Dis. 2017;65(11):1806-1812.
  • Özlü T, Bülbül Y, Özsu S. Ulusal verilerle toplumda gelişen pnömoniler. Tüberküloz Toraks Derg. 2007;55(2):191-212.
  • Özlü T. Toplum kökenli tipik pnömoniler. Sendrom. 1996;8(6):41-46.
  • Campbell GD. Overview of community-acquired pneumo- nia: prognosis and clinical features. Med Clin North Am. 1994;78(5):1035-1048.
  • Berg AS, Inchley CS, Fjaerli HO, et al. Clinical features and inflammatory markers in pediatric pneumonia: a prospective study. Eur J Pediatr. 2017;176:629-638.
  • Florin TA, Ambroggio L. Biomarkers for community-acquired pneumonia in the emergency department. Curr Infect Dis Rep. 2014;16:451. doi.org/10.1007/s11908-014-0451-8
  • Sintes H, Sibila O, Waterer GW, Chalmers JD. Severity assesment tools in CAP. Eur Respir Monogr. 2014;63:88-104.
  • Ewig S, Bauer T, Richter K, et al. Prediction of in-hospital death from community-acquired pneumonia by varying CRB-age groups. Eur Respir J. 2013;41(4):917-922.
  • Hohenthal U, Hurme S, Helenius H, et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect. 2009;15(11):1026-1032.
  • Van Vugt SF, Broekhuizen BDL, Lammens C. Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. BMJ. 2013;346:f2450.
  • Abers MS, Musher DM. Clinical prediction rules in community-acquired pneumonia: lies, damn lies and statistics. QJM Int J Med. 2014;107(7):595-596.
  • Lowsby R, Gomes C, Jarman I, et al. Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department. Emerg Med J. 2015;32(7):531-534.
  • de Jager CP, Wever PC, Gemen EF, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One. 2012;7(10):e46561.
  • Üçsular F, Polat G, Karadeniz G, et al. Predictive value of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with hypersensitivity pneumonia. Sarcoidosis Vasc Diffus Lung Dis. 2020;37(4):e2020012.
  • Şahin F, Feyza Aslan A, Koç Karaçar C. Which is the most effective inflammatory marker in the diagnosis, severity and treatment follow-up of patients with pneumonia? Eur Resp J. 2019;54(Suppl 63):PA4541.
  • Omran A, Awad H, Ibrahim M, et al. lung ultrasound and neutrophil lymphocyte ratio in early diagnosis and differentiation between viral and bacterial pneumonia in young children. Children. 2022;9(10):1457.
  • Cheng W, Chen L, Yu H, et al. Value of combining of the NLR and the fibrinogen level for predicting stroke-associated pneumonia. Neuropsychiatric Disease and Treatment. 2021;17:1697-1705.
  • Ng WWS, Lam SM, Yan WW, Shum HP. NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the ıntensive care unit. Sci Rep. 2022;12(1):15974.
  • Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474-488.
  • Damar Çakırca T, Torun A, Çakırca G, Portakal RD. Role of NLR, PLR, ELR andCLR in differentiating COVID-19 patients with and without pneumonia. Int J Clin Pract. 2021;75(11):e14781.
  • Koval D, Bielosludtseva K. Neutrophil-to-lymphocyte ratio (NLR) as a marker of COVID-19-associated pneumonia progression. Eur Resp J. 2022;60(Suppl 66):3533.
  • Curbelo J, Rajas O, Arnalich B, et al. Neutrophil count percentage and neutrophil-lymphocyte ratio as prognostic markers in patients hospitalized for community-acquired pneumonia. Arch Bronconeumol. 2019;55(9):472-477.
  • Ge YL, Zhang HF, Zhang Q, et al. Neutrophil-to-lymphocyte ratio in adult community-acquired pneumonia patients correlates with unfavorable clinical outcomes. Clin Lab. 2019;65(5):839-844.
  • Lee H, Kim I, Kang BH, Um SJ. Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia. PLoS ONE. 2021;16(4):e0250067.
  • Lee JH, Song S, Yoon SY, et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as diagnostic markers for pneumonia severity. Br J Biomed Sci. 2016;73(3):140-142.
  • Kuikel S, Pathak N, Poudel S, et al. Neutrophil–lymphocyte ratio as a predictor of adverse outcome in patients with community-acquired pneumonia: a systematic review. Health Sci Rep. 2022; 5(3):e630.
  • Meng Y, Zhang L, Huang M, Sun G. Blood heparin-binding protein and neutrophil-to-lymphocyte ratio as indicators of the severity and prognosis of community-acquired pneumonia. Resp Med. 2023;208:107144. doi.org/10.1016/j.rmed.2023.107144

Toplumdan Kazanılmış Pnömoni Hastalarında Prokalsitonin, C-Reaktif Protein, Kan Beyaz Küre Sayılarının ve Hemogram Alt Parametrelerinin Karşılaştırılması

Year 2023, Volume: 4 Issue: 6, 672 - 677, 31.12.2023

Mustafa İlteriş Bardakçı Gülhan Ayhan Albayrak

https://doi.org/10.47582/jompac.1394077

Abstract

Amaç: Pnömoni, akciğerlerin klinik ve radyolojik olarak tespit edilen inflamasyonudur. Pnömoni hastalarının büyük kısmını toplumdan kazanılmış pnömoni (CAP) vakaları oluşturur. Tanıyı desteklemekte ve tedavinin takibinde hemogram ve C-reaktif proteinin (CRP) kullanımı yaygındır. Prokalsitonin, daha az erişilebilir ve pahalıdır. Ve hemogram alt parametrelerinin kullanımı pek yaygın değildir. Bu çalışmanın amacı, pnömonisi olan olgularda prokalsitonin, CRP, Beyaz Küre sayısı (WBC) ve hemogram alt parametreleri arasındaki ilişkiyi ve ayırıcı tanıda yeni hematolojik oranların etkinliğini araştırmaktır.
Gereç ve Yöntem: Hastanemiz göğüs hastalıkları polikliniğine başvurarak toplumdan kazanılmış pnömoni tanısı alan olgular retrospektif olarak incelendi. Kadın-erkek fark etmeden klinik ve radyolojik olarak olarak tanı almış 67 hasta çalışmamıza dahil edildi. Olguların anamnez bilgileri ve ek hastalıkları sorgulandı. Hastaların prokalsitonin, CRP ve hemogram (nötrofil-lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR) ve monosit-lenfosit oranı (MLR) hesaplandı ve WBC değerine bakıldı) kaydedildi. Elde edilen veriler istatistik olarak değerlendirildi ve değişkenler açısından karşılaştırıldı.
Bulgular: Hastalarımızın yaş ortalaması 57 (18-71)’idi. 41 (%61,19) kadın ve 26 (%38,81) erkek hasta vardı. Hastalarımızın 36 (%53,73) tanesinin kronik hastalıkları mevcuttu; 21 (%31,34) tanesinde kalp hastalığı, 23 (%34,32) tanesinde diabet, 6 (%8,95) tanesinde böbrek yetmezliği vardı. Hastalarda; 48 (%71,64) prokalsitonin, 56 (%83,58) CRP, 38 (%56,71) WBC, 52 (%77,61) NLR, 34 (%50,74) PLR ve 38 (%56,71) MLR değerleri yüksekti. Prokalsitonin, CRP ve NLR değerleri diğer alt parametrelerinden daha anlamlı yüksekti. Ek bir kronik hastalığı olan hastaların CRP ve NLR değerleri ek hastalığı olmayan hastalardan daha yüksekti. Korelasyon analizlerinde prokalsitonin, CRP ve NRL arasında güçlü korelasyon vardı, diğerleri arasındaki korelasyon anlamlı değildi. (p <0.001).
Sonuç: Çalışmamız CAP hastalarında hemogram alt parametrelerinden NLR’nin güvenle kullanılabileceğini göstermektedir. Prokalsitoninin pahalı bir testtir. Birinci basamak aile sağlığı merkezlerinde Prokalsitoninin bulunmadığı ve CRP’nin bazı aile sağlığı merkezlerinde bulunduğu düşünüldüğünde NLR’nin hesaplanarak kullanılmasının tanıyı destekleyeceğini göstermiştir. İkinci ve üçüncü basamak sağlık tesislerinde de daha az tetkik kullanmak sağlık giderlerini azaltmak yönünden değerlidir.

Keywords

Pnömoni NLR Prokalsitonin CRP

References

  • Türk Toraks Derneği. Erişkinlerde toplumda gelişen pnömoniler tanı ve tedavi uzlaşı raporu. Buluş;2021.
  • Almiral J, Bolibar I,Vidal J, et al. Epidemiology of community acquired pneumonia in adults: apopulation –based study. Eur Respir J. 2000;15(4):757-763.
  • Theilacker C, Sprenger R, Leverkus F, et al. Population-based incidence and mortality of community-acquired pneumonia in Germany. PLoS One. 2021;16(6):e0253118.
  • T.C. Sağlık Bakanlığı, Refik Saydam Hıfzıssıhha Merkezi Başkanlığı Hıfzıssıhha Mektebi Müdürlüğü, Başkent Üniversitesi Ulusal Hastalık Yükü ve Maliyeti Etkinlik Projesi, 2004 (www.toraks.org.tr).
  • Wunderink RG. Community-acquired pneumonia. In: Cohen J, Powderly, Opal SM, eds. Infectious Diseases. 4th ed. Elsevier;2017:251-257.
  • Ramirez JA, Wiemken TL, Peyrani P, et al. Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality. Clin Infect Dis. 2017;65(11):1806-1812.
  • Özlü T, Bülbül Y, Özsu S. Ulusal verilerle toplumda gelişen pnömoniler. Tüberküloz Toraks Derg. 2007;55(2):191-212.
  • Özlü T. Toplum kökenli tipik pnömoniler. Sendrom. 1996;8(6):41-46.
  • Campbell GD. Overview of community-acquired pneumo- nia: prognosis and clinical features. Med Clin North Am. 1994;78(5):1035-1048.
  • Berg AS, Inchley CS, Fjaerli HO, et al. Clinical features and inflammatory markers in pediatric pneumonia: a prospective study. Eur J Pediatr. 2017;176:629-638.
  • Florin TA, Ambroggio L. Biomarkers for community-acquired pneumonia in the emergency department. Curr Infect Dis Rep. 2014;16:451. doi.org/10.1007/s11908-014-0451-8
  • Sintes H, Sibila O, Waterer GW, Chalmers JD. Severity assesment tools in CAP. Eur Respir Monogr. 2014;63:88-104.
  • Ewig S, Bauer T, Richter K, et al. Prediction of in-hospital death from community-acquired pneumonia by varying CRB-age groups. Eur Respir J. 2013;41(4):917-922.
  • Hohenthal U, Hurme S, Helenius H, et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect. 2009;15(11):1026-1032.
  • Van Vugt SF, Broekhuizen BDL, Lammens C. Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. BMJ. 2013;346:f2450.
  • Abers MS, Musher DM. Clinical prediction rules in community-acquired pneumonia: lies, damn lies and statistics. QJM Int J Med. 2014;107(7):595-596.
  • Lowsby R, Gomes C, Jarman I, et al. Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department. Emerg Med J. 2015;32(7):531-534.
  • de Jager CP, Wever PC, Gemen EF, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One. 2012;7(10):e46561.
  • Üçsular F, Polat G, Karadeniz G, et al. Predictive value of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with hypersensitivity pneumonia. Sarcoidosis Vasc Diffus Lung Dis. 2020;37(4):e2020012.
  • Şahin F, Feyza Aslan A, Koç Karaçar C. Which is the most effective inflammatory marker in the diagnosis, severity and treatment follow-up of patients with pneumonia? Eur Resp J. 2019;54(Suppl 63):PA4541.
  • Omran A, Awad H, Ibrahim M, et al. lung ultrasound and neutrophil lymphocyte ratio in early diagnosis and differentiation between viral and bacterial pneumonia in young children. Children. 2022;9(10):1457.
  • Cheng W, Chen L, Yu H, et al. Value of combining of the NLR and the fibrinogen level for predicting stroke-associated pneumonia. Neuropsychiatric Disease and Treatment. 2021;17:1697-1705.
  • Ng WWS, Lam SM, Yan WW, Shum HP. NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the ıntensive care unit. Sci Rep. 2022;12(1):15974.
  • Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474-488.
  • Damar Çakırca T, Torun A, Çakırca G, Portakal RD. Role of NLR, PLR, ELR andCLR in differentiating COVID-19 patients with and without pneumonia. Int J Clin Pract. 2021;75(11):e14781.
  • Koval D, Bielosludtseva K. Neutrophil-to-lymphocyte ratio (NLR) as a marker of COVID-19-associated pneumonia progression. Eur Resp J. 2022;60(Suppl 66):3533.
  • Curbelo J, Rajas O, Arnalich B, et al. Neutrophil count percentage and neutrophil-lymphocyte ratio as prognostic markers in patients hospitalized for community-acquired pneumonia. Arch Bronconeumol. 2019;55(9):472-477.
  • Ge YL, Zhang HF, Zhang Q, et al. Neutrophil-to-lymphocyte ratio in adult community-acquired pneumonia patients correlates with unfavorable clinical outcomes. Clin Lab. 2019;65(5):839-844.
  • Lee H, Kim I, Kang BH, Um SJ. Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia. PLoS ONE. 2021;16(4):e0250067.
  • Lee JH, Song S, Yoon SY, et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as diagnostic markers for pneumonia severity. Br J Biomed Sci. 2016;73(3):140-142.
  • Kuikel S, Pathak N, Poudel S, et al. Neutrophil–lymphocyte ratio as a predictor of adverse outcome in patients with community-acquired pneumonia: a systematic review. Health Sci Rep. 2022; 5(3):e630.
  • Meng Y, Zhang L, Huang M, Sun G. Blood heparin-binding protein and neutrophil-to-lymphocyte ratio as indicators of the severity and prognosis of community-acquired pneumonia. Resp Med. 2023;208:107144. doi.org/10.1016/j.rmed.2023.107144
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Details

Primary Language English
Subjects Chest Diseases
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Mustafa İlteriş Bardakçı 0000-0002-9038-4049

Gülhan Ayhan Albayrak 0000-0003-1802-3844

Publication Date December 31, 2023
Submission Date November 22, 2023
Acceptance Date December 19, 2023
Published in Issue Year 2023 Volume: 4 Issue: 6

Cite

AMA Bardakçı Mİ, Ayhan Albayrak G. Comparison of procalcitonin, C-reactive protein, white blood cell counts and hemogram subparameters in community acquired pneumonia patients. J Med Palliat Care / JOMPAC / jompac. December 2023;4(6):672-677. doi:10.47582/jompac.1394077
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