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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Mortality during follow-up according to the neutrophil count percentage &#40;panel A&#41; and the neutrophil&#47;lymphocyte ratio &#40;panel B&#41; measured in the early-stage blood test&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Community-acquired pneumonia &#40;CAP&#41; is a common infection that is potentially deadly&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1&#44;2</span></a> One of the objectives in the care of CAP patients at the time of diagnosis is to establish an estimated prognosis&#44; in order to determine the need for hospitalization or for planning the most suitable follow-up&#46; Numerous scales for assessing CAP severity and risk are available for this purpose&#44; such as the CURB65 criteria &#40;confusion&#44; urea&#44; respiratory rate&#44; blood pressure&#44; age&#62;65 years&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> the Pneumonia Severity Index &#40;PSI&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> and the Severe Community Acquired Pneumonia &#40;SCAP&#41; score&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> These scales have been widely validated in large population cohorts and are currently the most useful tools available for assessing the prognosis of CAP patients at the time of diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Efforts are currently underway to improve the prognostic value of these clinical scales&#46; Given that pneumonia is a localized infectious process that causes a systemic inflammatory response&#44; it is postulated that the study of this inflammatory process would assist in evaluating the severity of CAP and predicting its progress&#46; In this respect&#44; several biomarkers determined at the time of CAP diagnosis have been studied&#44; including procalcitonin &#40;PCT&#41;&#44; proadrenomedullin &#40;proADM&#41; and copeptin<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9&#8211;14</span></a>&#59; these molecules measured at diagnosis have shown a greater prognostic power than C-reactive protein &#40;CRP&#41; or total leukocyte count&#44; but have not proven to be superior to traditional scales&#46; Several authors have reassessed the use of simpler&#44; more accessible markers at diagnosis&#44; such as the neutrophil&#47;lymphocytes ratio &#40;NLR&#41;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">15&#44;16</span></a> or the neutrophil count percentage &#40;NCP&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> with the advantage that both are easily identifiable&#44; inexpensive parameters&#46; Along these lines&#44; Curbelo et al&#46; compared NCP with PCT&#44; proADM&#44; and copeptin&#44; and found it was not significantly inferior in terms of its prognostic capacity for mortality in the short and medium term&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Continuing in the search for efficient biomarkers&#44; other authors have proposed simple&#44; economic parameters and evaluated their usefulness not only for diagnosis&#44; but also for the follow-up of patients with CAP&#46; Zhydkov et al&#46; found that total leukocyte counts and CRP in patients hospitalized for CAP provided prognostic information if they were evaluated in clinical laboratory tests during patient follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> Other studies also show that NLR and NCP in early-stage blood tests &#40;at 3&#8211;5 days&#41; are equally or more useful than determinations made on admission&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> and suggest that these 2 parameters may be very useful prognostic markers of the progress of patients hospitalized for CAP&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate the usefulness of NCP and NLR measured during the course of CAP&#44; and their role as predictors of mortality at 30 and 90 days&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective study of CAP patients admitted to the respiratory medicine or internal medicine department of the Hospital Universitario de La Princesa in Madrid between 2010 and 2012&#46; The study protocol was approved by the Clinical Research Ethics Committee of the same center&#46; Provisions for data collection reflected in the applicable legislation&#44; Act 15&#47;1999 on Personal Data Protection&#44; were followed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The inclusion criteria were&#58; age&#62;18 years at the time of diagnosis and hospitalization for CAP in the departments of Respiratory Medicine or Internal Medicine&#46; We determined that both the admission and discharge reports listed the primary diagnosis as CAP&#44; and the presence of lower respiratory tract symptoms &#40;cough&#44; expectoration&#44; dyspnea&#44; tachypnea or pleuritic pain&#41; and the appearance of a new infiltrate on X-ray without any other justifiable cause&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> Only patients with clinical laboratory tests performed at the time of CAP diagnosis and at least once more before hospital discharge were included&#46; This second test was the one performed 3&#8211;5 days after the date of admission&#46; Total leukocytes and differential counts were determined from peripheral blood in EDTA&#44; and by fluorescence flow cytometry and hydrodynamic focusing &#40;forward and side scatter with a Sysmex XE-2100&#8482; automated hematology analyzer &#40;Sysmex&#44; Kobe&#44; Japan&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We excluded patients who did not receive antibiotics in the context of a decision to limit treatment&#46; Exclusion criteria included the presence of active hematologic or oncologic disease and severe immunodeficiency &#40;transplant recipients or patients with human immunodeficiency virus infection with &#60;500 CD4&#43;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients were classified using the PSI and CURB65 assessment scales&#44; and their sociodemographic characteristics&#44; comorbidities&#44; and treatment were systematically recorded&#46; We calculated the modified Charlson comorbidity index proposed by Bord&#243;n et al&#46; for patients with CAP&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> In addition&#44; clinical&#44; radiological&#44; and laboratory variables associated with the CAP episode were recorded&#46; The definitions of some of these diseases are given in the <a class="elsevierStyleCrossRef" href="#sec0045">Annex</a>&#46; Patients were treated according to the routine clinical practice&#44; following the therapeutic recommendations of the main European clinical guidelines&#46; The main outcome variable was all-cause death 30 and 90 days after CAP diagnosis&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical Analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Differences between qualitative variables were analyzed using the Chi-squared test or&#44; in the case of expected frequencies lower than 5&#44; Fisher&#39;s exact test&#46; Differences in the quantitative variables were analyzed using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test or&#44; in the case of non-normally distributed variables&#44; the non-parametric Wilcoxon test&#46; An inter-subject analysis was performed to assess changes in NCP and NLR between the determinations at diagnosis and follow-up&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We analyzed the predictive power of NCP and NLR on 90-day mortality by calculating areas under the ROC curve &#40;AUC&#41;&#46; We also analyzed the usefulness of cut-off points for NCP and NLR proposed in the literature&#59; in the case of NLR&#44; the usefulness of the cutoff point of 10 proposed by de Jager et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> was analyzed&#46; For NCP&#44; the cutoff point of 85 proposed in previous articles by our research group<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> was analyzed&#46; For this evaluation&#44; we calculated the hazard ratio &#40;HR&#41; or incidence ratio of mortality as a function of NCP and NLR&#59; subsequently&#44; a multivariate adjustment was made using the Cox regression model&#44; including the variables that showed differences with <span class="elsevierStyleItalic">P</span>&#60;0&#46;10&#44; applying clinical criteria to obtain a parsimonous model&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">For the calculation of the sample size&#44; we used data from the gold-standard prospective study&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> In that study&#44; patients with NCP&#62;85&#37; in the early-stage test had a 90-day mortality rate of 55&#37; compared to the group with NCP&#60;85&#37;&#44; who had a mortality rate of 7&#46;5&#37;&#46; The ratio between the two groups was 1&#58;12&#44; so for an alpha error of 5&#37; and a power of 95&#37;&#44; a sample size of 173 subjects was required&#46; Similar results were obtained for the NLR cutoff point of 10 in the early-stage test&#46; Based on these data&#44; a target sample size of 200 subjects was established&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Probability values were considered statistically significant at <span class="elsevierStyleItalic">P</span>&#60;0&#46;05&#46; The statistical analysis was carried out with Stata software &#40;version 13&#46;1&#59; Stata Corporation&#44; College Station&#44; Texas&#44; USA&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 275 patients were analyzed in a consecutive and undirected manner&#46; Twenty-eight episodes were excluded because of readmissions and 38 because of unavailable blood tests at 3&#8211;5 days&#46; The final sample was composed of 209 patients&#44; in order to reach the estimated sample size &#40;200 patients&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nine patients &#40;4&#46;3&#37;&#41; died during hospitalization &#40;95&#37; confidence interval &#91;CI&#93;&#58; 2&#46;3&#8211;8&#41;&#44; whereas 5&#46;7&#37; had died by day 30 &#40;95&#37; CI&#58; 3&#46;3&#8211;9&#46;8&#41;&#46; Ninety days after diagnosis&#44; 25 patients had died&#44; with a cumulative mortality of 12&#37; &#40;95&#37;&#58; 8&#46;2&#8211;17&#46;1&#41; Baseline characteristics of the study population and differences between those who had died and those who survived at 90 days can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Patients who died had a higher average age &#40;85&#46;7 years vs 73&#46;2&#59; <span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41;&#46; This subgroup of patients showed a prevalence of cognitive impairment&#44; malnutrition&#44; and a significantly greater history of bronchoaspiration&#46; Comorbidity measured by the Charlson index was slightly higher in patients who died&#59; in that group&#44; 88&#37; had an index of 2 or higher&#44; compared to 70&#46;7&#37; in the group of survivors&#59; however&#44; this difference did not reach statistical significance &#40;<span class="elsevierStyleItalic">P</span>&#61;0&#46;075&#41;&#46; Moreover&#44; patients who progressed adversely had a significantly higher level of CAP severity evaluated by PSI or CURB65&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The analysis of the relationship between NCP and NLR with mortality is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; It can be seen that patients who died and those who progressed well showed similar NCP values in their tests on admission &#40;84&#46;8&#37; vs 85&#46;8&#37;&#44; <span class="elsevierStyleItalic">P</span>&#61;0&#46;794&#41; and the same occurs with NLR &#40;9&#46;9 vs 10&#46;1&#59; <span class="elsevierStyleItalic">P</span>&#61;0&#46;652&#41;&#46; In contrast&#44; in the early early-stage test&#44; significant differences were found between the non-survivors and the survivors for both NCP &#40;74&#37; vs 65&#46;4&#37;&#44; <span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41; and NLR &#40;6&#46;9 vs 3&#46;2&#59; <span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41;&#46; When intra-subject progress is analyzed&#44; patients who survived are seen to present a significant reduction in NCP between tests on admission and early-stage tests &#40;&#8722;19&#46;1&#44; <span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41;&#59; the same is true of NLR &#40;&#8722;6&#46;9&#44; <span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41;&#46; However&#44; while the non-survivors experienced a decrease in their NCP &#40;&#8722;4&#46;4&#41;&#44; this reduction was not significant &#40;<span class="elsevierStyleItalic">P</span>&#60;0&#46;166&#41;&#46; The same situation occurred with NLR &#40;reduction of &#8722;1&#46;6 with <span class="elsevierStyleItalic">P</span>&#61;0&#46;183&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">On the basis of the cutoff points proposed in previous studies&#44; patients were stratified according to their NCP and NLR levels at admission or in early-stage tests&#58; NCP&#62;85&#37; or NLR&#62;10 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The analysis of NCP shows that patients with values&#62;85&#37; at admission and at discharge had a mortality rate at 30 days of 30&#37;&#44; and 40&#37; at 90 days&#46; On the other hand&#44; subjects with NCP&#60;85&#37; at admission but whose NCP in the early-stage test subsequently rose to &#62;85&#37; had a 30-day mortality rate of 33&#46;3&#37; and 66&#46;7&#37; at 90 days&#46; At the other extreme&#44; patients who had levels persistently lower than 85&#37;&#44; or those who began with high levels that then fell&#44; had significantly lower 30-day &#40;4&#46;3 and 3&#37;&#44; respectively&#41; and 90-day &#40;9&#46;8&#37; and 7&#46;9&#37;&#41; mortality rates&#46; A similar situation occurs when the progress of NLR is analyzed&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the ROC curves for NCP and NLR in the early-stage blood tests for 90-day mortality&#46; The AUC for NCP was 70&#46;9 &#40;95&#37; CI&#58; 58&#46;3&#8211;83&#46;6&#41; and 74 for NLR &#40;95&#37; CI&#58; 62&#46;1&#8211;86&#41; For 30-day mortality&#44; the AUC of NCP in the early-stage test was 84 &#40;95&#37; CI&#58; 72&#46;1&#8211;96&#41; and 88&#46;3 for NLR &#40;95&#37; CI&#58; 79&#46;4&#8211;97&#46;2&#41;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">With regard to the assessment tools&#44; the AUC for the CURB65 score was 68&#46;4 &#40;95&#37; CI&#58; 59&#46;4&#8211;77&#46;5&#41; for 90-day mortality and 69&#46;8 &#40;95&#37; CI&#58; 59&#46;2&#8211;80&#46;4&#41; for 30-day mortality&#46; The AUC of the PSI score for 90-day mortality was 76&#46;7 &#40;95&#37; CI&#58; 69&#46;9&#8211;83&#46;6&#41; and 78&#46;4 &#40;95&#37; CI&#58; 69&#8211;87&#46;8&#41; for 30-day mortality&#46; None of the scores was statistically superior to NLR or NCP values in the early-stage blood test&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">To assess the predictive power of these parameters in the early-stage blood test&#44; the HR for 90-day mortality was calculated&#46; Thus&#44; NCP&#62;85&#37; in the early-stage test was accompanied by an HR for 90-day mortality of 8&#46;16 &#40;95&#37; CI&#58; 3&#46;5&#8211;19&#41;&#44; that is to say&#44; an 8-fold mortality risk compared to patients with NCP&#60;85&#37;&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows mortality as a function of NCP&#46; After adjusting for age&#44; sex&#44; malnutrition&#44; a history of stroke&#44; cognitive impairment&#44; a history of bronchoaspiration&#44; and CAP severity evaluated by CURB65&#44; the HR was 12 &#40;95&#37; CI&#58; 4&#46;3&#8211;33&#46;3&#41;&#44; that is to say&#44; statistical significance was maintained&#46; In the analysis of the difference in NCP between admission and early-stage blood tests&#44; a reduction of 10 units was associated with a statistically significant adjusted HR of 0&#46;67 &#40;0&#46;50&#8211;0&#46;90&#41;&#46; That is to say&#44; subjects who had achieved a 10&#37; reduction in NCP during follow-up had a risk of mortality one-third lower than those whose NCP did not fall&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The situation was similar in the case of the NLR &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44; panel B&#41;&#46; A value of NLR&#62;10 in the early-stage test was accompanied by a univariate HR for 90-day mortality of 6&#46;1 &#40;95&#37; CI&#58; 2&#46;6&#8211;14&#46;2&#41;&#44; and after multivariate adjustment&#44; the HR&#44; at 6&#46;5&#44; was statistically significant &#40;95&#37; CI&#58; 2&#46;5&#8211;16&#46;7&#41;&#46; In the analysis of the difference of NLR between admission and early-stage blood tests&#44; a reduction of NLR of 5 units was associated with a statistically significant adjusted HR of 0&#46;83 &#40;0&#46;70&#8211;0&#46;98&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The analysis of 30-day mortality showed similar results&#58; after multivariate adjustment&#44; the HR for the NCP cutoff point of 85&#37; in the early-stage blood test was 18&#46;3 &#40;95&#37; CI&#58; 3&#46;8&#8211;88&#46;6&#41; and 9&#46;9 for the NLR cutoff of 10 &#40;95&#37; CI&#58; 2&#46;5&#8211;38&#46;7&#41;&#46; In this case&#44; a reduction of 10 percentage points from the baseline NCP value in the early-stage test compared to the value at admission was accompanied by an HR of 0&#46;5 &#40;95&#37; CI&#58; 0&#46;3&#8211;0&#46;9&#41; Similarly&#44; a reduction in NLR of 5 units in the respective tests was associated with an HR of 0&#46;8 &#40;95&#37; CI&#58; 0&#46;6&#8211;0&#46;9&#41;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">This series of patients hospitalized for CAP demonstrates the prognostic value of NCP and NLR&#46; High levels of NCP and NLP at admission are poorer markers of mortality than persistently high or rising values during hospitalization&#46; The presence of NCP&#62;85&#37; or NLR&#62;10 in the early-stage blood test is associated with a high risk of mortality regardless of age&#44; sex&#44; comorbidities&#44; or CAP severity evaluated by the conventional scores&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Patients who do not survive do not show a significant reduction in NCP or NLR over the course of their disease&#44; while those with initially low levels experience an increase in these markers&#46; This finding suggests that an uncontrolled immune response&#44; in which neutrophils predominate over other leukocytes &#40;NCP&#41; or over the lymphocyte population &#40;NLR&#41;&#44; could be a sign of persistent and ineffective immune response indicative of adverse clinical outcomes&#46; Zhydkov et al&#46; performed blood tests at admission&#44; on days 3&#44; 5&#44; and 7&#44; and at discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> In their study&#44; they demonstrated the prognostic value not only of PCT&#44; but also of the total leukocyte count and CRP&#44; less so in the initial tests&#44; and markedly in the early-stage tests&#46; Unfortunately&#44; in this study NCP and NLR data were not provided&#44; and AUC for the isolated markers were not calculated&#46; In previous studies&#44; our group performed 2 blood tests in a prospective cohort of patients with CAP requiring hospitalization and demonstrated the utility of parameters such as NLR and NCP at admission&#44; but especially in early-stage tests&#44; finding a prognostic power comparable to that of other molecules&#44; such as proADM&#44; PCT&#44; and copeptin&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> This study strengthens the evidence provided by these previous papers&#44; stressing the usefulness of blood tests as part of the early-stage monitoring of progress in patients with severe CAP requiring hospitalization&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">There is abundant evidence to show that PCT is the most useful biomarker for monitoring the progress of respiratory infections&#46; Normalization of PCT levels has been correlated with clinical improvement in patients with pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> Furthermore&#44; several clinical trials show that clinical management guided by levels of circulating PCT in patients with lower respiratory tract infections may lead to a reduction in the duration of antibiotic treatment&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#44;23</span></a> although this latter assertion is controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">24&#44;25</span></a> None of these studies has compared PCT with NCP or NLR&#46; The few publications that directly compare PCT with NLR or NCP are observational studies&#44; in which NCP and NLR show no inferiority when measured at admission or in early-stage tests&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> This study supports the results obtained by other groups on the usefulness of NCP and NLR as prognostic markers in the course of the infectious process&#46; In addition&#44; its findings raise the possibility that monitoring patients on the basis of these simple parameters may be sufficient&#44; with the consequent cost savings&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Both the CURB65 and PSI indices help stratify the risk of CAP patients at the time of diagnosis&#44; and no biomarker has consistently shown superiority over these scales&#46; After diagnosis&#44; the only indicator for patients with severe CAP available to the clinician is the course of the disease itself&#46; In the subgroup of patients with severe CAP&#44; the determination of NCP or NLR in early-stage blood tests would help identify patients at increased risk for adverse outcomes and indicate the need to intensify monitoring and plan close observation&#46; It should be pointed out that while the NLR or NCP AUCs for 30-day and 90-day mortality in the early-stage blood test are similar to those of CURB65 or PSI&#44; they are not comparable&#46; The CAP assessment scales stratify the risk at the time of diagnosis&#44; while NLR or NCP becomes useful in the post-acute phase&#44; after the start of antibiotic treatment&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">This study follows the lines of other authors who suggest the need to use new biomarkers in clinical practice&#46; Simple&#44; low-cost parameters&#44; such as NCP or NLR&#44; can provide clinically useful information&#46; Moreover&#44; as most studies compare biomarkers with CRP or total leukocyte counts&#44; it seems reasonable that any new biomarker must be compared with these 2 parameters&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The main limitations of this study are its retrospective&#44; single-centre design&#46; Moreover&#44; the cohort of CAP patients was restricted to those who were hospitalized and presented clinical laboratory results&#44; so the full spectrum of severity of the disease is not represented&#46; The inclusion of hospitalized subjects implies the exclusion of patients with mild CAP who would receive outpatient management&#46; Furthermore&#44; the criterion of requiring an early-stage blood test meant that some patients with a severe disease course and early death might have been excluded&#46; Another potential limitation is the fact that the blood tests were carried 3&#8211;5 days after admission instead of on a specific day&#46; Although this factor might generate a certain degree of imprecision&#44; it provides the study with a degree of pragmatism and reflects clinical practice&#58; protocolized blood tests performed on fixed days are unlikely to be translatable to day-to-day care&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">NCP and NLR are accessible&#44; inexpensive parameters that provide information on the prognosis of patients with severe CAP when analyzed in early follow-up&#44; within 3&#8211;5 days following a diagnosis of pneumonia&#46; High NLR or NCP values after several days of hospitalization for CAP are associated with an increased risk of 90-day mortality&#44; regardless of comorbidities and the severity of the pneumonia&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">This study was funded by the <span class="elsevierStyleGrantSponsor" id="gs1">Instituto de Salud Carlos III</span> &#40;European Regional Development Fund&#41; &#40;<span class="elsevierStyleGrantNumber" refid="gs1">PI 12&#47;01142</span> and <span class="elsevierStyleGrantNumber" refid="gs1">PI 15&#47;01311</span>&#41; and by the <span class="elsevierStyleGrantSponsor" id="gs2">Spanish Society of Pulmonology and Thoracic Surgery</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs2">SEPAR 89&#47;2013</span> and <span class="elsevierStyleGrantNumber" refid="gs2">SEPAR 98&#47;2016</span>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of Interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46;</p></span></span>"
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          "titulo" => "Materials and Methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Statistical Analysis"
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          "titulo" => "Results"
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          "titulo" => "Funding"
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          "identificador" => "sec0040"
          "titulo" => "Conflict of Interests"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-05-25"
    "fechaAceptado" => "2019-02-12"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1148983"
          "palabras" => array:4 [
            0 => "Community-acquired pneumonia"
            1 => "Neutrophil&#8211;lymphocyte ratio"
            2 => "Neutrophil count percentage"
            3 => "Biomarkers"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1148982"
          "palabras" => array:4 [
            0 => "Neumon&#237;a adquirida en la comunidad"
            1 => "Cociente neutr&#243;filos&#47;linfocitos"
            2 => "Porcentaje de neutr&#243;filos"
            3 => "Biomarcadores"
          ]
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Community-acquired pneumonia &#40;CAP&#41; is a common serious infection&#46; This study aimed to evaluate the prognostic utility of neutrophil count percentage &#40;NCP&#41; and neutrophil&#8211;lymphocyte ratio &#40;NLR&#41; in patients with CAP&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of hospitalized patients with CAP&#46; Patients had a blood test at admission and 3&#8211;5 days after hospitalization &#40;early-stage test&#41;&#46; The main outcome variables were 30-day and 90-day mortality&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Two hundred and nine patients were included&#46; Patients who survived had significant reductions in both NCP and NLR between admission and the day 3&#8211;5 blood tests &#40;from 85&#46;8&#37; to 65&#46;4&#37; for NCP and from 10&#46;1 to 3&#46;2 for NLR&#41;&#46; Twenty-five patients died in the first 90 days&#46; Patients who died had lower&#44; non-significant reductions in NCP &#40;from 84&#46;8&#37; to 74&#37;&#41; and NLR &#40;from 9&#46;9 to 6&#46;9&#41; and significantly higher early-stage NCP and NLR than those who survived&#46; NCP values higher than 85&#37; and NLR values higher than 10 in the early-stage blood test were associated with a higher risk of mortality&#44; even after multivariate adjustment &#40;HR for NCP&#58; 12&#59; HR for NLR&#58; 6&#46;5&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">NCP and NLR are simple&#44; low-cost parameters with prognostic utility&#44; especially when measured 3&#8211;5 days after CAP diagnosis&#46; High NLR and&#47;or NCP levels are associated with a greater risk of mortality at 90 days&#46;</p></span>"
        "secciones" => array:4 [
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La neumon&#237;a adquirida en la comunidad &#40;NAC&#41; es una infecci&#243;n frecuente y grave&#46; El objetivo de este trabajo es estudiar la utilidad pron&#243;stica del porcentaje de neutr&#243;filos &#40;NCP&#41; y del cociente neutr&#243;filos&#47;linfocitos &#40;NLR&#41; en pacientes con NAC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de pacientes hospitalizados por NAC con anal&#237;tica al ingreso y una segunda extracci&#243;n de control a los 3-5 d&#237;as&#46; Se consideraron variables desenlace la mortalidad a 30 y 90 d&#237;as&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 209 pacientes&#46; Los pacientes que sobrevivieron redujeron significativamente el NCP y el NLR entre la anal&#237;tica al diagn&#243;stico y la de control &#40;desde el 85&#44;8 hasta el 65&#44;4&#37; para NCP y de 10&#44;1 a 3&#44;2 para NLR&#41;&#46; Fallecieron 25 pacientes en los primeros 90 d&#237;as&#46; En ellos hubo un menor descenso no significativo para el NCP &#40;del 84&#44;8 al 74&#44;0&#37;&#41; y para NLR &#40;de 9&#44;9 a 6&#44;9&#41;&#46; Los valores de NCP y NLR en la anal&#237;tica de control fueron significativamente mayores en los pacientes fallecidos que en los supervivientes&#46; Aquellos pacientes que presentaron en la anal&#237;tica de control un NCP superior al 85&#37; o un NLR superior a 10&#44; presentaron un riesgo de mortalidad superior tras ajuste multivariable &#40;HR para NCP 12 y para NLR 6&#44;5&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">NCP y NLR son par&#225;metros sencillos y de bajo coste&#44; con utilidad pron&#243;stica especialmente al medirse a los 3-5 d&#237;as del diagn&#243;stico de NAC&#46; Niveles altos de NLR o NCP se asocian con mayor riesgo de mortalidad a los 90 d&#237;as&#46;</p></span>"
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            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Curbelo J&#44; Rajas O&#44; Arnalich B&#44; Galv&#225;n-Rom&#225;n JM&#44; Luquero-Bueno S&#44; Ortega-G&#243;mez M&#44; et al&#46; Estudio del porcentaje de neutr&#243;filos y el cociente de neutr&#243;filos-linfocitos como marcadores pron&#243;sticos en pacientes hospitalizados por neumon&#237;a adquirida en la comunidad&#46; Arch Bronconeumol&#46; 2019&#59;55&#58;472&#8211;477&#46;</p>"
      ]
    ]
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      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dementia&#46;</span> Dementia is a clinical syndrome characterized by global acquired memory and intellect impairment and personality disorder occurring in an alert&#44; awake individual&#46; For this study&#44; a patient was considered to have dementia when his&#47;her score on the Lobo&#39;s Mini Examen Cognoscitivo &#40;MEC-30&#44; Spanish equivalent of the Mini-Mental State Examination&#41; was less than 24 or when his&#47;her score on the Global Dementia Score &#40;GDS&#41; was greater than or equal to 4&#46;</p> <p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Malnutrition&#46;</span> Malnutrition is defined as the alteration of the body composition due to absolute or relative deprivation of nutrients that produces a decrease in nutritional parameters below the third percentile&#46; For the purposes of classification&#44; subjects with COntrolling NUTritional status &#40;CONUT&#41; scores greater than or equal to 5 &#40;risk of moderate or severe malnutrition&#41; were considered to be malnourished&#46;</p> <p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">History of bronchoaspiration</span>&#46; Bronchoaspiration is the abnormal passage of fluid&#44; exogenous substances or endogenous secretions to the lower airways&#46; In this study&#44; a patient was considered to have a history of bronchoaspiration in 2 situations&#58; &#40;1&#41; patients with at least 1 episode of chemical pneumonitis or infectious pneumonia following an episode of bronchoaspiration witnessed by family members or caregivers&#59; &#40;2&#41; patients with neurodegenerative diseases&#44; cerebrovascular disease or fragility&#44; with high risk of dysphagia&#44; who had previously performed an ENT test for dysphagia with a positive result&#44; despite not having presented witnessed bronchoaspirative episodes&#46;</p>"
            "etiqueta" => "Annex"
            "titulo" => "Definitions of conditions"
            "identificador" => "sec0045"
          ]
        ]
      ]
    ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Analysis of changes in neutrophil count percentage &#40;panel A&#41; and neutrophils&#47;lymphocytes ratio &#40;panel B&#41; according to 90-day mortality&#46;</p>"
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        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ROC curves for 90-day mortality for the neutrophil&#47;lymphocyte ratio &#40;NLR&#41; and the neutrophil count percentage &#40;NCP&#41; measured in early-stage blood test&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Mortality during follow-up according to the neutrophil count percentage &#40;panel A&#41; and the neutrophil&#47;lymphocyte ratio &#40;panel B&#41; measured in the early-stage blood test&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">COPD&#58; chronic obstructive pulmonary disease&#59; PSI&#58; Pneumonia Severity Index&#59; PYI&#58; pack-year index in smokers and ex-smokers&#59; SD&#58; standard deviation&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">74&#46;7 &#40;16&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;401<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">101 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Former smoker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;18&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PYI mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49&#46;1 &#40;27&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&#46;8 &#40;28&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#46;5 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;337<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asthma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;600<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5 &#40;26&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49 &#40;26&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;918<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obese&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">27 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;14&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;051<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">44 &#40;21&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;710<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">110 &#40;52&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95 &#40;51&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;447<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">52 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45 &#40;24&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;712<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stroke&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">25 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19 &#40;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;092<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic renal disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">23 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;321<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;16&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;633<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;20&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;16&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malnutrition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;14&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>History of bronchoaspiration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Prognostic scales&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>I&#8211;II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;65&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Community-acquired pneumonia"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;G&#46; Wunderink"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2014"
                        "volumen" => "370"
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                      "titulo" => "Clinical and economic burden of community-acquired pneumonia among adults in Europe"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Welte"
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                    0 => array:2 [
                      "doi" => "10.1136/thx.2009.129502"
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                        "tituloSerie" => "Thorax"
                        "fecha" => "2012"
                        "volumen" => "67"
                        "paginaInicial" => "71"
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                            2 => "R&#46; Laing"
                            3 => "W&#46;G&#46; Boersma"
                            4 => "N&#46; Karalus"
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                      "titulo" => "A prediction rule to identify low-risk patients with community-acquired pneumonia"
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                            3 => "B&#46;H&#46; Hanusa"
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                      "doi" => "10.1056/NEJM199701233360402"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1997"
                        "volumen" => "336"
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                        "paginaFinal" => "250"
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                      "titulo" => "Validation and comparison of SCAP as a predictive score for identifying low-risk patients in community-acquired pneumonia"
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                            4 => "R&#46; Diez"
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Journal Information
Vol. 55. Issue 9.
Pages 472-477 (September 2019)
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3471
Vol. 55. Issue 9.
Pages 472-477 (September 2019)
Original Article
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Neutrophil Count Percentage and Neutrophil–Lymphocyte Ratio as Prognostic Markers in Patients Hospitalized for Community-Acquired Pneumonia
Estudio del porcentaje de neutrófilos y el cociente de neutrófilos-linfocitos como marcadores pronósticos en pacientes hospitalizados por neumonía adquirida en la comunidad
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Jose Curbeloa, Olga Rajasb, Belén Arnalichc, José María Galván-Romána, Sergio Luquero-Buenod, Mara Ortega-Gómezd, Angel Lanchoc, Emilia Roya, Ana Sánchez Azofrab, Gloria Mateo Jiménezc, Manuel Gómeze, Fernando Moldenhauera, Javier Aspab,
Corresponding author
jaspa@separ.es

Corresponding author.
a Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
b Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, Spain
c Servicio de Neumología, Hospital del Henares, Coslada, Madrid, Spain
d Biobanco del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
e Unidad de Metodología, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
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Tables (2)
Table 1. Baseline Characteristics of the Study Population by 90-Day Mortality.
Table 2. Analysis of 30-Day and 90-Day Mortality by the Neutrophil Count Percentage (NCP) and Neutrophil/Lymphocyte Ratio (NLR).