Using neutrophil to lymphocyte ratio to predict discharge among geriatric patients with influenza infection in emergency department

Abstract

The neutrophil-to-lymphocyte ratio (NLR) is used to predict the prognosis of various diseases, such as coronavirus disease 2019, community-acquired pneumonia, bacteremia, and endocarditis. However, NLR has never been reported to predict patient discharge in geriatric patients with influenza infection. This retrospective case-control study enrolled geriatric patients (≥65 years) with influenza virus infection who visited the emergency department of a medical center between January 01, 2010 and December 31, 2015. Demographic data, vital signs, past histories, influenza subtypes, outcomes, and disposition were analyzed. The optimal NLR cut-off value to predict patient discharge was determined using the Youden index. We also evaluated the accuracy of NLR in predicting patient discharge using logistic regression and receiver operating characteristic analysis. The study included 409 geriatric patients in the emergency department with a mean age of 79.5 years and an approximately equal sex ratio. NLR was significantly lower in the discharged group than in the nondischarged group (5.8 ± 3.7 vs 9.7 ± 8.4). Logistic regression revealed that patients with NLR ≤ 6.5 predicted discharge with an odds ratio of 3.62. The Hosmer–Lemeshow goodness-of-fit test was calculated as 0.36, and the adjusted area under the receiver operating characteristic was 0.75. The negative predictive value of NLR ≤ 6.5, to predict patient discharge, was 91.8%. NLR ≤ 6.5 is a simple and easy-to-obtain laboratory tool to guide the physicians to discharge geriatric patients with influenza infection in the crowded emergency department.

Correlation of Hemoglobin Level With New Inflammatory Markers in the Emergency Department: A Retrospective Study Exploring Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte, and Mean Platelet Volume-to-Platelet Count Ratios

“…[16] When comparing laboratory values between referred and non-referred groups, we found that the referred group had significantly lower Hb levels and significantly higher NLR, MLR, and PLR values. These results are consistent with other studies that found anemia associated with increased hospital admission rates in patients with chronic obstructive pulmonary disease (COPD) [17], as well as higher NLR values in geriatric influenza patients who were not discharged [18]. The elevated MLR and PLR in the referred-to medical ward group also highlight the potential of these inflammatory markers, as previous studies show higher NLR, MLR, and PLR values at admission in deceased coronavirus disease 2019 (COVID-19) patients compared to survivors [19].…”

“…When using ROC analysis to investigate the predictive ability of these ratios regarding referral to the medical ward, we found that the NLR/Hb ratio was the most predictive. In their study, Jheng et al have shown the predictive ability of NLR for discharge in elderly patients with influenza, using a cutoff of NLR ≤ 6.5 [ 18 ]. In our study, NLR/Hb ratio was found to be more predictive than NLR alone for medical ward referral.…”

Blood cell count combined with lower respiratory symptoms predict the risk of pulmonary complications in patients with influenza A without risk factors

“…Among these indicators, NLR had the best predictive effect on pulmonary complications of in uenza A, and its optimal cut-off value was 10.228, indicating that NLR(neutrophil/lymphocyte) > 10.228 could be used as the best single predictor of pulmonary complications in patients without high-risk factors of in uenza A. Previous studies have also veri ed that WBC, neutrophils and NLR can evaluate the prognosis of in uenza patients [27] and predict the severity of COVID-19 [28-29], which is consistent with this study. SII is a new systemic immune-in ammatory index, which is widely used in tumor and autoimmune diseases [30].…”