Analysis of Neutrophil/Lymphocyte Ratio and Culture Results on Clinical Severity of Patients with CAP

Abstract

Community-Acquired Pneumonia (CAP) is an acute infection with high morbidity and mortality, especially among toddlers and elders in Indonesia. Culture is the gold standard for infectious diseases, which requires a long time. Therefore, a rapid, inexpensive, easy-to-use marker such as NLR is needed. To analyze the relationship of NLR and culture results with the clinical severity of CAP. A retrospective study with a cross-sectional design was performed using secondary data from CAP patients at Dr. Wahidin Sudirohusodo Hospital from January 1^st, 2018 to July 31^st, 2021. The study conducted on 113 samples showed no significant differences between NLR and clinical severity of CAP (p-value of 0.071). However, the mean value of NLR in severe CAP was higher (6±4.74) than in moderate CAP (2.58±1.8) with no significant correlation (p-value 0.071). There was a significant difference in culture on the clinical severity of CAP (p-value 0.005). A positive correlation was found between culture and clinical severity of CAP (p-value 0.004) with weak correlation strength (r=0.266). NLR is an early detection marker of infection. Stimulation of growth hormone causes an increase in neutrophil count, apoptosis acceleration, and lymphocyte redistribution; therefore, increased neutrophils are common in severe clinical conditions. The insignificant relationship between NLR and clinical severity might be caused by the therapeutic intervention given. The ATS/IDSA guidelines stated that culture results were positive in 4-15%. The mean NLR value in severe CAP was slightly higher than that of moderate CAP, but no significant difference was found. There was a weak correlation between culture results and the clinical severity of CAP patients.