Investigation of the effectiveness of the rate of neurophil lymphocyt in the estimation of the prognosis of the disease in 65 years and older with community-acquired pneumoni̇a patients in emergency service

OBJECTIVE:Theaimofthisstudywastoevaluatetheprognosisofthediseasebylookingat the NLR levels of patients aged 65 and over. In addition, the NLR level in patients diagnosed with CAP was compared with other infection markers to have an idea about thedisease. MATERİALS AND METHODS: This study included patients aged 65 years and older who were admitted to the Emergency Department of the Atatürk Training and Research Hospitalof Ankara Yıldırım Beyazıt University between January 2016 and December 2017 with the diagnosis of community-acquired pneumonia. The study was performed with a retrospective observational method. The demographic data, vital signs, laboratory parameters and radiological examinations of the patients included in the study were examined via HBYS system. The dates of application, gender and presence of additional diseases were recorded in the follow-upforms.. RESULTS: A total of 628 patients with CAP were included in the study. 267 (42.5%) of the patientswerefemaleand361(57.5%)weremale.Themeanageoftheparticipantswas78(65- 98). While 14 (2.2%) of the patients diagnosed with CAP were receiving Invasive Mechanical Ventilatorsupport,29(4.6%)patientsreceivednoninvasivemechanicalventilatorsupport,and 9 (1.4%) patients received vasopressor support. While 305 (48.6%) of the patients diagnosed withCAPweretreatedasoutpatients,253(40.3%)wereinpatientintheChestDiseaseService and 70 (11.1%) patients received treatment in the Intensive Care Unit. Mortality rates of the patientswereexaminedand33(5.3%)patientsdiedinthefirst28days,and40(6.4%)patients died in six months. 28-day mortality risk has increased in patients with heart failure, cerebrovascular disease and active tumor. 28-day mortality rates were significantly increased inpatientswithConsciousnessDisorder,RespirationRateof29,SystolicBloodPressurebelow 90mmHg,Pulserateofmorethan124perminute,PaO2<60orSaO2<90.The28-day Mortality rates of patients with acidosis (ph<7.35), BUN value greater than 29, detected pleural effusion in radiological examinations and hyperglycaemia (Glucose> 249) were significantly increased. The 28-day mortality rate was 42.9%, 20.7% and 33.3% for IMV, NIMV and Vasopressor support, respectively. The relationship between the parameters showing the infection status and the 28-day mortality was investigated and the values of Procalcitonin (p: 0,039) and Lactate (p: 0,011) were found to be effective in showing the 28-day mortality. The NLR value is different between the patients who are dischargedand the patients admitted to the hospital. However, the difference between those in the Service and Intensive Care Unit is not significant. Although the area under the curve is significant in the ROC analysis for NLR to distinguish inpatients and discharged patients, NLR cannot be interpreted as a strong marker for this purpose. CONCLUSION:NLR level is not effective inpredicting the mortality of patients. In this study, PSI, PCT and Lactate were found to be more effective. On the other hand, there is adifference between the patients who were discharged and admitted to the hospital in terms of NLR value. We can use this value for safedischarge.