Predictive value of NLR in community-acquired pneumonia with initial treatment failure and the use of NGS in this disease pathogen
Objective To assess the predictive value of neutrophil-lymphocyte ratio(NLR)for community-acquired pneumonia(CAP)with initial treatment failure and to explore the value of second-generation sequencing technology(NGS)in the detection of CAP pathogens with initial treatment failure.Method Retrospective analysis of 188 patients with CAP treated at Jilin Provincial People's Hospital from January 2023 to January 2024.Based on the patients'response to the initial treatment after 72 h,the patients were divided into the initial treatment effective group(n=139)and the initial treatment failure group(n=49),and the differences in the levels of blood,procalcitonin(PCT),and NLR were compared between the groups,and the risk factors affecting the occurrence of the initial treatment failure in patients with CAP were screened according to the dichotomous logistic regression method.The predictive value of NLR for CAP of initial treatment failure was analyzed based on subject work characteristics(ROC)curves and compared with CURB-65 scores.Thirty of these CAP patients who failed initial treatment underwent both NGS and conventional pathogenetic testing to compare the differences in pathogen detection results between the two testing methods.Results NLR,PCT,blood white blood cell count(WBC),and neutrophil count(NEU)were higher in the initial treatment failure group than in the initial treatment effective group,and lymphocyte count(LYM)was lower than in the initial treatment effective group(P<0.05);The CURB-65 score was high-er in the initial treatment failure group than in the initial treatment effective group(P<0.05).Binary logistic regression showed that NLR was an independent predictor of CAP for initial treatment failure.ROC curve analysis showed that the NLR had a higher predictive value for CAP of initial treatment failure compared with the classical index CURB-65 score[area under the curve(AUC):0.746 vs 0.698,both P>0.05].In this study When the NLR cutoff value was 6.62,the sensitivity was 65.3%and the specificity was 77.7%.Compared with traditional testing methods,NGS had a higher positive rate for pathogenic microorganisms(66.7%vs 33.3%,P<0.05),and more types of microorganisms were detected(35 vs 14).Conclusion NLR is an independent risk factor for the occurrence of initial treatment failure in patients with CAP and has a high independent predictive value.NGS,as a novel pathogen detection technol-ogy with a high positive rate compared with traditional testing methods,provides a more rapid and accurate pathogen detection technology for CAP that has failed initial treatment,which not only increases the cure rate but also improves the long-term prognosis of patients.
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