title: Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio.
abstract: BACKGROUND
  The increase and persistence of inflammation in community-acquired pneumonia (CAP) patients can lead to higher mortality. Biomarkers capable of measuring this inadequate inflammatory response are likely candidates to be related with a bad outcome. We investigated the association between concentrations of several inflammatory markers and mortality of CAP patients.
  
  
  METHODS
  This was a prospective study of hospitalised CAP patients in a Spanish university hospital. Blood tests upon admittance and in the early-stage evolution (72-120 hours) were carried out, where C-reactive protein, procalcitonin, proadrenomedullin, copeptin, white blood cell, Lymphocyte Count Percentage (LCP), Neutrophil Count Percentage (NCP) and Neutrophil/Lymphocyte Ratio (NLR) were measured. The outcome variable was mortality at 30 and 90 days. Statistical analysis included logistic regression, ROC analysis and area-under-curve test.
  
  
  RESULTS
  154 hospitalised CAP patients were included. Patients who died during follow-up had higher levels of procalcitonin, copeptin, proadrenomedullin, lower levels of LCP, and higher of NCP and NLR. Remarkably, multivariate analysis showed a relationship between NCP and mortality, regardless of age, severity of CAP and comorbidities. AUC analysis showed that NLR and NCP at admittance and during early-stage evolution achieved a good diagnostic power. ROC test for NCP and NLR were similar to those of the novel serum biomarkers analysed.
  
  
  CONCLUSIONS
  NLR and NCP, are promising candidate predictors of mortality for hospitalised CAP patients, and both are cheaper, easier to perform, and at least as reliable as the new serum biomarkers. Future implementation of new biomarkers would require comparison not only with classic inflammatory parameters like White Blood Cell count but also with NLR and NCP.
authors.affiliation: Department of Internal Medicine, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Curbelo
authors.affiliation: Biobank, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Luquero Bueno
authors.affiliation: Department of Immunology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Galván-Román
authors.affiliation: Biobank, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Mara
authors.initials: M
authors.lastname: Ortega-Gómez
authors.affiliation: Department of Pneumology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Rajas
authors.affiliation: Clinical Information Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Fernández-Jiménez
authors.affiliation: Methodology Unit, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Vega-Piris
authors.affiliation: Methodology Unit, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodríguez-Salvanes
authors.affiliation: Department of Pneumology, Hospital del Henares, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Arnalich
authors.affiliation: Department of Clinical Analysis, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Díaz
authors.affiliation: Department of Internal Medicine, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Costa
authors.affiliation: Department of Immunology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Hortensia
authors.initials: H
authors.lastname: de la Fuente
authors.affiliation: Department of Immunology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Lancho
authors.affiliation: Department of Internal Medicine, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez
authors.affiliation: Department of Pneumology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Ancochea
authors.affiliation: Department of Pneumology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Javier
authors.identifier: http://orcid.org/0000-0002-1283-995X
authors.initials: J
authors.lastname: Aspa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D017714:Community-Acquired Infections / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008214:Lymphocytes; D008297:Male; D009504:Neutrophils; D010343:Patient Admission; D011014:Pneumonia / Q000097:blood / Q000401:mortality*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers