Valeur pronostique du rapport neutrophiles/lymphocytes chez les patients gravement malades atteints de pneumonie sévère
DOI :
https://doi.org/10.62438/tunismed.v104i09.6735Mots-clés :
Rapport, Neutrophile, Lymphocyte, Pneumonie, Unité de soins intensifs, PronosticRésumé
Introduction : La pneumonie communautaire (PC) est l'une des principales causes d'admission en soins intensifs. Plusieurs études ont suggéré le rôle potentiel du rapport neutrophiles/lymphocytes (RNL) dans la stratification du risque et le pronostic chez les patients septiques. Notre objectif était d'évaluer la valeur pronostique du RNL à l'admission en soins intensifs chez les patients hospitalisés pour PC.
Méthodes : Nous avons mené une étude de cohorte observationnelle prospective monocentrique dans l'unité de soins intensifs médicaux sur une période de six mois, de juillet 2024 à décembre 2024. Nous avons inclus les patients de plus de 18 ans admis en soins intensifs pour une pneumonie communautaire.
Résultats : Cent vingt-six patients ont été inclus, d’âge médian de 68 ans et présentant un sex-ratio de 1,13. Les principales comorbidités étaient le diabète (48,8 %), l’hypertension (47,6 %) et la dyslipidémie (41,2 %). Les scores APACHE II et SAPS II étaient respectivement de 7,7 ± 4,4 et 24 ± 7,4. Une ventilation mécanique invasive a été indiquée chez 30 patients (23,8 %). Trente et un patients (24,6 %) étaient en état de choc et 31 patients (24,6 %) présentaient un SDRA. Le taux de mortalité était de 46 %, avec une durée médiane d’hospitalisation de 5 jours. Le rapport neutrophiles/ lymphocytes (NLR) médian était de 8,85. Un NLR > 9 était associé à la mortalité (p < 10⁻³),....( résumé tronqué à 250 mots).
Téléchargements
Références
Pneumonia. WHO. April 3, 2021.
Hayes BH, Haberling DL, Kennedy JL, Varma JK, Fry AM, VoraNM. Burden of pneumonia-associated hospitalizations: United
States, 2001–2014. Chest 2018, 153(2) :427-37, Doi: 10.1016/j. chest.2017.09.041.
Kwas H, Habibech S, Zendah I, Khattab A, Ghedira H. Particularités de la pneumopathie aigue communautaire chez le sujet âgé. Tunis
Med. Feb 2017;95.
Kolditz M, Ewig S. Community-acquired pneumonia in adults. Dtsch Ärztebl Int 2017;114(49):838–48. DOI: 10.3238/arztebl.2017.0838.
Ramirez JA, Wiemken TL, Peyrani P, et al. Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and
mortality. Clin Infect Dis 2017;65(11):1806-1812, Doi: 10.1093/cid/ cix647.
Ewig S, Bauer T, Richter K, Szenscenyi J, Heller G, Strauss R et al. Prediction of in-hospital death from community-acquired
pneumonia by varying CRB-age groups. Eur Respir J 2013. 41(4):917-922, DOI: 10.1183/09031936.00065212
Chalmers JD, Singanayagam A, Akram AR, Mandal P, Short PM, Choudhury G et al. Severity assessment tools for predicting
mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax 2010
Oct;65(10):878-83. DOI: 10.1136/thx.2009.133280
Guo S, Mao X, Liang M. The moderate predictive value of serial serum CRP and PCT levels for the prognosis of hospitalized
community-acquired pneumonia. Respir Res. 2018 Oct 1;19(1):193. DOI: 10.1186/s12931-018-0877-x
Zhydkov A, Christ-Crain M, Thomann R, Hoess C, Henzen C, Werner Z, et al. Utility of procalcitonin, Creactive protein and white blood
cells alone in combination for the prediction of clinical outcomes in community- acquired pneumonia. Clin Chem Lab Med 2015;53:
–66. DOI: 10.1515/cclm-2014-0456
Schuetz P, Suter-Widmer I, Chaudri A, Christ-Crain M, Zimmerli W, Mueller B, et al. Prognostic value of procalcitonin in community-
acquired pneumonia. Eur Respir J 2011;37:384–392. DOI: 10.1183/09031936.00035610
Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis
and bacterial community-acquired pneumonia. Ann Lab Med 2013;33:105–110. DOI: 10.3343/alm.2013.33.2.105
Zhang J, Feng G, Zhao Y, Zhang J, Feng L, Yang J. Association between lymphocyte-to-monocyte ratio (LMR) and the mortality of
HBV-related liver cirrhosis: a retrospective cohort study. BMJ Open 2015 Aug 21;5(8):e008033. DOI: 10.1136/bmjopen-2015-008033
Nomelini RS, Carrijo Chiovato A, Abdulmassih F, Da Silva R, Tavares- Murta B, Murta E. Neutrophil-To-lymphocyte ratio and platelet
count as prognostic factors in ovarian malignancies. J Cancer Res Ther 2019;15:1226–30. DOI: 10.4103/jcrt.JCRT_304_17.
Zhang HF, Ge YL, Wang HY, Zhang Q, Li WQ, Chen Y, et al. Neutrophil- to-lymphocyte ratio improves the accuracy and sensitivity of
pneumonia severity index in predicting 30-day mortality of CAP patients. Clin. Lab 2019; 65: e190226. DOI: 10.7754/Clin. Lab.2019.190226.
Ge YL, Zhang HF, Zhang Q, Zhu XY, Liu CH, Wang N, et al. Neutrophil-to-lymphocyte ratio in adult community-acquired pneumonia
patients correlates with unfavorable clinical outcomes. Clin. Lab 2019; 65: e181042, DOI: 10.7754/Clin.Lab.2018.181042.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious diseases society of america/american
thoracic society consensus guidelines on the management of community acquired pneumonia in adults. Clin. Infect. Dis 2007; 44
Suppl 2: S27–72. DOI: 10.1086/511159.
Matthay MA, Arabi Y, Arroliga AC, Bernard G, Bersten AD, Brochard LJ, Calfee CS. A New Global Definition of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2024 Jan 1;209(1):37-47, DOI: 10.1164/rccm.202303-0558WS.
Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin Kidney J
;6:8-14, DOI: 10.1093/ckj/sfs160.
Sikora A, Zahra F. Nosocomial infections [Internet]. StatPearls Publishing; 2023, PMID: 32644738.
Angus DC, Van Der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369:840-51, DOI: 10.1056/NEJMra1208623.
Pneumonia in adults : diagnosis and management. NICE 2023. PMID : 31940163.
Kuikel S, Pathak N, Poudel S, Thapa S, Bhattarai SL, Chaudhary G et al. Neutrophil–lymphocyte ratio as a predictor of adverse outcome in patients with community-acquired pneumonia: A systematic review. Health Sci Rep 2022;5(3):e630, DOI: 10.1002/hsr2.630.
Meng Y, Zhang L, Huang M, Sun G. Blood heparin-binding protein and neutrophil-to-lymphocyte ratio as indicators of the severity
and prognosis of community-acquired pneumonia. Respir Med 2023 Mar;208:107144, DOI: 10.1016/j.rmed.2023.107144.
Lee H, Kim I, Kang BH, Um SL. Prognostic value of serial neutrophil- to-lymphocyte ratio measurements in hospitalized community-
acquired pneumonia. PLOS ONE 2021 Apr 15;16(4):e0250067, DOI:10.1371/journal.pone.0250067.
TekinA, WirekoFW, GajicO,OdeyemiYE.Theneutrophil/lymphocyte ratio and outcomes in hospitalized patients with community-
acquired pneumonia: A retrospective cohort study. Biomedicines 2024;12(2):260, DOI: 10.3390/biomedicines12020260.
Ge YL, Zhang HF, Zhang Q, Zhu XY, Liu CH, Wang N et al. Neutrophil- to-lymphocyte Ratio in adult Community-Acquired Pneumonia
Patients correlates with unfavorable clinical outcomes. Clin Lab 2019 May 1;65(5). DOI: 10.7754/Clin.Lab.2018.181042.
Sharma Y, Thompson C, Zinellu A, Shahi R, Horwood C, Mangoni A. The role of the neutrophil-to-lymphocyte ratio in predicting
outcomes among patients with community-acquired pneumonia. Clin Med 2025;25(1):100278. DOI: 10.1016/j.clinme.2024.100278.
Huang L, Weng B, Wang M, Weng J, Du X, Ju Y et al. The improved prediction value of neutrophil to lymphocyte ratio to pneumonia
severity scores for mortality in the older people with community- acquired pneumonia. BMC Geriatr 2025 Jul 2;25:485. DOI: 10.1186/
s12877-025-06121-2.
Altas OF, Kizilkaya M. The effects of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and prognostic markers in
determining the mortality in patients diagnosed with pneumonia in intensive care. Medeni Med J 2021;36(2):130-137. DOI: 10.5222/
MMJ.2021.64160.
Kakehi E,Uehira R, Ohara N, Akamatsu Y, Osaka T, Sakurai S et al. Utility of the New Early Warning Score (NEWS) in combination with
the neutrophil–lymphocyte ratio for the prediction of prognosis in older patients with pneumonia. Fam Med Community Health 2023
Jun 21;11(2):e002239. DOI: 10.1136/fmch-2023-002239
Fichiers supplémentaires
Publiée
Numéro
Rubrique
Licence
Merci de créditer les auteurs lors de toute citation : La Tunisie Médicale (2026)
Ce travail est disponible sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
