Can N-terminal pro B-type natriuretic peptide, neutrophil-to-lymphocyte ratio, C-reactive protein help to predict...

Area of Science:

• Critical Care Medicine
• Pulmonology
• Biomarkers in Medicine

Background:

• Limited data exists on predicting intensive care unit (ICU) and short/long-term mortality in severe community-acquired pneumonia (CAP) using neutrophil-to-lymphocyte ratio (NLR), N-terminal proB-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP).
• Existing severity indexes may not fully capture mortality risk in severe CAP patients.

Purpose of the Study:

• To evaluate the predictive performance of NLR, NT-proBNP, and CRP for ICU, short-term, and long-term mortality in severe CAP patients.
• To compare the efficacy of these biomarkers against established scoring systems like APACHE II and CURB65.

Main Methods:

• A retrospective cohort study was conducted in a level III ICU.
• 143 patients with severe CAP were enrolled.
• Statistical analysis was performed to assess the predictive accuracy of NLR, NT-proBNP, CRP, APACHE II, and CURB65 for various mortality outcomes.

Main Results:

• APACHE II scoring demonstrated significantly higher predictive performance for ICU mortality (p = 0.002).
• NLR showed significant predictive performance for short-term mortality (p = 0.039), while NT-proBNP was significant for long-term mortality (p = 0.002).
• Patients with a CURB65 score ≥ 4 exhibited significantly higher mortality (p = 0.047).

Conclusions:

• NLR and NT-proBNP (≥ 2000 pg/mL) can predict pneumonia severity in the ICU, similar to CURB65 and the Pneumonia Severity Index (PSI).
• Elevated NLR, APACHE II scores, and the presence of atrial fibrillation are significant factors for long-term mortality.
• Clinicians should prioritize cardiac evaluation and follow-up for CAP patients due to the impact of cardiac factors on mortality.