C-reactive protein, procalcitonin, and neutrophil-to-lymphocyte ratio as mortality predictors in elderly women with pneumonia

Abstract

Aim: Pneumonia is the leading cause of morbidity and mortality among elderly individuals. This has led to the search for reliable tools such as inflammatory biomarkers, including C-reactive protein (CRP), procalcitonin (PCT), and neutrophil-to-lymphocyte ratio (NLR), to predict disease severity and prognosis. However, the prognostic value of inflammatory biomarkers in elderly women is not fully understood, as the population is often underrepresented in clinical studies. Methods: This retrospective study was conducted at Wahidin Sudirohusodo Hospital, Indonesia. The samples used were elderly women aged ≥ 60 years who were hospitalized with community-acquired pneumonia (CAP) between January and December 2023. CRP, PCT, and NLR levels collected within 24 hours of admission were evaluated and correlated with pneumonia severity index (PSI) scores and in-hospital mortality (IHM). Subsequently, receiver operating characteristic (ROC) curve analysis, logistic regression, and Kaplan-Meier survival analysis were performed. Results: A total of 262 patients (median age 66 years) were included, of whom 83.2% had mild CAP, and 87.0% survived. Among inflammatory biomarkers, CRP showed the highest, with limited discriminatory ability for mortality [area under the curve (AUC) 0.543], followed by NLR (AUC 0.495), and PCT (AUC 0.466). All markers had high sensitivity (91.2%) but low specificity, and CRP ≥ 14.5 mg/L was significantly associated with reduced survival (p = 0.018). Conclusions: CRP shows a modest prognostic value in predicting mortality among elderly women with CAP, while NLR and PCT have limited utility. These results show the need for gender- and age-specific studies to improve risk stratification and outcomes in the vulnerable population.

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