Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
권호 표지
DOI QR코드

DOI QR Code

Neutrophil-to-lymphocyte Ratio as A Predictor of Aspiration Pneumonia in Drug Intoxication Patients

약물중독 환자에서 Neutrophil Lymphocyte Ratio의 흡인성폐렴 발생 예측인자로서의 고찰

  • Lee, Jeong Beom (Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Lee, Sun Hwa (Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Yun, Seong Jong (Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine) ;
  • Ryu, Seokyong (Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Choi, Seung Woon (Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Kim, Hye Jin (Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Kang, Tae Kyung (Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Oh, Sung Chan (Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Cho, Suk Jin (Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Seo, Beom Sok (Department of Emergency Medicine, Nowon Eulji Medical Center, Eulji University)
  • 이정범 (인제대학교 상계백병원 응급의학과) ;
  • 이선화 (인제대학교 상계백병원 응급의학과) ;
  • 윤성종 (경희대학교 강동경희대병원 영상의학과) ;
  • 류석용 (인제대학교 상계백병원 응급의학과) ;
  • 최승운 (인제대학교 상계백병원 응급의학과) ;
  • 김혜진 (인제대학교 상계백병원 응급의학과) ;
  • 강태경 (인제대학교 상계백병원 응급의학과) ;
  • 오성찬 (인제대학교 상계백병원 응급의학과) ;
  • 조석진 (인제대학교 상계백병원 응급의학과) ;
  • 서범석 (을지대학교 노원을지병원 응급의학과)
  • Received : 2018.09.06
  • Accepted : 2018.10.25
  • Published : 2018.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and occurrence of aspiration pneumonia in drug intoxication (DI) patients in the emergency department (ED) and to evaluate the relationship between NLR and length of hospital admission/intensive care unit (ICU) admission Methods: A total of 466 patients diagnosed with DI in the ED from January 2016 to December 2017 were included in the analysis. The clinical and laboratory results, including NLR, were evaluated as variables. NLR was calculated as the absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of DI, data on the development of aspiration pneumonia were obtained. Also, we evaluated the relationship between NLR and length of hospital admission and between NLR and length of ICU admission. Statistically, multivariate logistic regression analyses, receiver-operating characteristic (ROC) curve analysis, and Pearson's correlation (${\rho}$) were performed. Results: Among the 466 DI patients, 86 (18.5%) developed aspiration pneumonia. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting aspiration pneumonia (odds ratio, 1.7; p=0.001). NLR showed excellent predictive performance for aspiration pneumonia (areas under the ROC curves, 0.815; cut-off value, 3.47; p<0.001) with a sensitivity of 86.0% and a specificity of 72.6%. No correlations between NLR and length of hospital admission (${\rho}=0.195$) and between NLR and length of ICU admission (${\rho}=0.092$) were observed. Conclusion: The NLR is a simple and effective marker for predicting the occurrence of aspiration pneumonia in DI patients. Emergency physicians should be alert for aspiration pneumonia in DI patients with high NLR value (>3.47).

Keywords

References

  1. Henderson A, Wright M, Pond SM. Experience with 732 acute overdose patients admitted to an intensive care unit over six years. Med J Aust 1993;158:28-30.
  2. Wilson KC, Saukkonen JJ. Acute respiratory failure from abused substances. J Intensive Care Med 2004;19:183-93. https://doi.org/10.1177/0885066604263918
  3. Satar S, Seydaoglu G. Analysis of acute adult poisoning in a 6-year period and factors affecting the hospital stay. Adv Ther 2005;22:137-47. https://doi.org/10.1007/BF02849884
  4. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths-United States, 2000-2014. MMWR Morb Mortal Wkly Rep 2016;64:1378-82. https://doi.org/10.15585/mmwr.mm6450a3
  5. Leroy O, Vandenbussche C, Coffinier C, Bosquet C, Georges H, Guery B, Thevenin D, Beaucaire G. Community-acquired aspiration pneumonia in intensive care unit: Epidemiological and prognosis data. Am J Respir Crit Care Med 1997;156:1922-9. https://doi.org/10.1164/ajrccm.156.6.9702069
  6. Mier L1, Dreyfuss D, Darchy B, Lanore JJ, Djedaini K, Weber P, Brun P, Coste F. Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures. Intensive Care Med 1993;19:279-84. https://doi.org/10.1007/BF01690548
  7. Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: A prospective study. Chest 1999;115:178-83. https://doi.org/10.1378/chest.115.1.178
  8. Marik PE: Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344: 665-71. https://doi.org/10.1056/NEJM200103013440908
  9. Lu Y, Song Z, Zhou X, Huang S, Zhu D, Yang CBX, et al. A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med 2004;30:2197-203. https://doi.org/10.1007/s00134-004-2479-y
  10. Christ A, Arranto CA, Schindler C, Klima T, Hunziker PR, Siegemund M, et al. Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients. Intensive Care Med 2006;32:1423-7. https://doi.org/10.1007/s00134-006-0277-4
  11. Narstaran EM, Saghaei M, Alfred S, Zargarzadeh AH, Huynh C, Gheshlaghi F, et al. Comparative Evaluation of Glasgow Coma Score and Gag Reflex in Predicting Aspiration Pneumonitis in Acute Poisoning. J Crit Care 2009;24:470.e9-15.
  12. Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet 1996;348:123-4.
  13. Geoffrey K, Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit Care Med 2004;32:88-93. https://doi.org/10.1097/01.CCM.0000104207.42729.E4
  14. Liisanantti J, Kaukoranta P, Martikainen M, Ala-Kokko T. Aspiration pneumonia following severe self-poisoning. Resuscitation 2003;56:49-53. https://doi.org/10.1016/S0300-9572(02)00284-8
  15. Zahorec R. 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.
  16. Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017;35:234-9. https://doi.org/10.1016/j.ajem.2016.10.055
  17. Ewig S, Torres A. Severe community-acquired pneumonia: how to assess illness severity. Monaldi Arch Chest Dis 1999;54:250-4.
  18. Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit Care Med 2004;32:88-93. https://doi.org/10.1097/01.CCM.0000104207.42729.E4
  19. Taneja R, Parodo J, Jia SH, Kapus A, Rotstein OD, Marshall JC. Delayed neutrophil apoptosis in sepsis is associated with maintenance of mitochondrial transmembrane potential and reduced caspase-9 activity. Crit Care Med 2004;32:1460-9. https://doi.org/10.1097/01.CCM.0000129975.26905.77
  20. Soehnlein O, Lindbom L. Phagocyte partnership during the onset and resolution of inflammation. Nat Rev Immunol 2010;10:427-39. https://doi.org/10.1038/nri2779
  21. Nauseef WM, Borregaard N. Neutrophils at work. Nat Immunol 2014;7:602-11.
  22. Maitre B, Magnenat S, Heim V, Ravanat C, Evans RJ, de la Salle H, et al. The P2X1 receptor is required for neutrophil extravasation during lipopolysaccharide-induced lethal endotoxemia in mice. J Immunol 2015;194:739-49. https://doi.org/10.4049/jimmunol.1401786
  23. Zhang Y, Wu W, Dong L, Yang C, Fan P, Wu H. Neutrophil to lymphocyte ratio predicts persistent organ failure and inhospital mortality in an Asian Chinese population of acute pancreatitis. Medicine (Baltimore) 2016;95:e4746. https://doi.org/10.1097/MD.0000000000004746
  24. Beliaev AM, Angelo N, Booth M, Bergin C. Evaluation of neutrophil-to-lymphocyte ratio as a potential biomarker for acute cholecystitis. J Surg Res 2016;209:93-101.
  25. Piciucchi M, Stigliano S, Archibugi L, Zerboni G, Signoretti M, Barucca V, et al. The neutrophil/lymphocyte ratio at diagnosis is significantly associated with survival in metastatic pancreatic cancer patients. Int J Mol Sci 2017;18:e730. https://doi.org/10.3390/ijms18040730
  26. Gul U, Kayani AM, Munir R, Hussain S. Neutrophil lymphocyte ratio: a prognostic marker in acute ST elevation myocardial infarction. J Coll Physicians Surg Pak 2017;27:4-7.
  27. Xue J, Huang W, Chen X, Li Q, Cai Z, Yu T, et al. Neutrophilto-lymphocyte ratio is a prognostic marker in acute ischemic stroke. J Stroke Cerebrovasc Dis 2017;26:650-7. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.11.010
  28. Kundi H, Balun A, Cicekcioglu H, Cetin M, Kiziltunc E, Cetin ZG, et al. The relation between platelet-to-lymphocyte ratio and Pulmonary Embolism Severity Index in acute pulmonary embolism. Heart Lung 2015;44:340-3. https://doi.org/10.1016/j.hrtlng.2015.04.007
  29. Kim JH, Kim HJ, Na JU, Han SK, Choi PC, Shin DH. Hematologic parameters to predict negative cerebrospinal fluid examination results among neurologically intact patients who underwent lumbar puncture on suspicion of central nervous system infection. Clin Exp Emerg Med 2017;4:25-31. https://doi.org/10.15441/ceem.16.152