EMR Combined with CRB-65 Superior to CURB-65 in Predicting Mortality in Patients with Community-Acquired Pneumonia

Yi Sun; Hong Wang; Minghao Gu; Xingyu Zhang; Xiudi Han; Xuedong Liu

doi:10.2147/IDR.S443045

EMR Combined with CRB-65 Superior to CURB-65 in Predicting Mortality in Patients with Community-Acquired Pneumonia

Infect Drug Resist. 2024 Feb 8:17:463-473. doi: 10.2147/IDR.S443045. eCollection 2024.

Authors

Yi Sun^{1

2}, Hong Wang³, Minghao Gu⁴, Xingyu Zhang⁵, Xiudi Han¹, Xuedong Liu¹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital Group, Qingdao, Shandong Province, 266000, People's Republic of China.
² School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, 261000, People's Republic of China.
³ Hospital-Acquired Infection Control Department, Qingdao Municipal Hospital Group, Qingdao, Shandong Province, 266000, People's Republic of China.
⁴ School of Medicine, Qingdao University, Qingdao, Shandong Province, 266000, People's Republic of China.
⁵ Human Resources Department, Qingdao Municipal Hospital Group, Qingdao, Shandong Province, 266000, People's Republic of China.

Abstract

Background: Data about eosinophil-to-lymphocyte ratio (ELR) and eosinophil-to-monocyte ratio (EMR) in patients with community-acquired pneumonia (CAP) are rare. We aimed to evaluate the role of EMR and ELR in predicting disease severity and mortality in patients with CAP.

Methods: A total of 454 patients (76 with severe CAP (SCAP), 378 with non-SCAP) were enrolled from November 18, 2020, and November 21, 2021. Laboratory examination on day 1 after admission was measured. The ELR and EMR values were calculated for patients. Propensity score matching (PSM) was performed to balance potential confounding factors. Binary logistic regression model was fitted to identify the potential risk factors for disease severity and Cox proportional hazards regression model analysis for mortality in CAP. Receiver operating characteristic (ROC) analysis was performed to distinguish disease severity and mortality.

Results: EMR and ELR at admission were significantly lower in SCAP patients than in non-SCAP patients (P<0.001). EMR < 0.018 ([OR] = 12.104, 95% CI: 4.970-29.479), neutrophil (NEU) ([OR]=1.098, 95% CI:1.005-1.199), and age ([OR]=1.091, 95% CI:1.054-1.130) were independent risk factors for disease severity of CAP. EMR < 0.032 ([HR] = 5.816, 95% CI: 1.704-9.848) was an independent predictor of in-hospital mortality. Combining EMR or ELR with CRB-65 improved the overall accuracy of disease severity prediction (AUC from 0.894 to 0.937), the same as CURB-65. The area under the curve of EMR (AUC=0.704; 95% CI: 0.582-0.827) to predict in-hospital mortality was higher than that of CURB-65 (AUC=0.619; 95% CI: 0.484-0.754). Otherwise, EMR combined with CRB-65 (AUC=0.721; 95% CI: 0.592-0.851) had significantly higher diagnostic accuracy for in-hospital mortality than that of CURB-65 alone.

Conclusion: EMR combined with CRB-65 was superior to CURB-65 in predicting mortality in patients with CAP. This new combination was simpler and easier to obtain for physicians in clinics or admission, and it was more convenient for early recognition of patients with poor prognoses.

Keywords: CRB-65; CURB-65; ELR; EMR; community-acquired pneumonia; mortality; severity of disease.