Biomarcadores sanguíneos predictores de pronóstico clínico y severidad de enfermedades respiratorias bajas en adultos mayores. Revisión Sistemática de Literatura

Authors

Edison Jhoel Llanos Arteaga
María José Ortega López
Mateo Sebastián Parra Ordóñez
Alberto Dario Diaz Parra
Lupe Katherine Guevara Escudero

Abstract

Introduction: Lower respiratory tract diseases are among the leading causes of morbidity and mortality in older adults. Age-related immunological changes have encouraged the search for accessible biomarkers capable of identifying patients at increased risk of complications and mortality at an early stage. Materials and Methods: A systematic literature review was conducted following the PRISMA guidelines. The search was performed in PubMed, Scopus, SciELO, Dialnet, and Redalyc databases using DeCS and MeSH descriptors related to blood biomarkers, lower respiratory tract diseases, and older adults. After applying the inclusion and exclusion criteria, 15 studies were selected for qualitative evidence synthesis. Results: The included studies identified the neutrophil-to-lymphocyte ratio (NLR) as the hematological biomarker with the greatest prognostic value in older adults with community-acquired pneumonia, chronic obstructive pulmonary disease, COVID-19, and respiratory syncytial virus infection. Elevated NLR values were associated with greater clinical severity, intensive care unit admission, need for mechanical ventilation, and mortality. Furthermore, the integration of NLR with prognostic scales such as CURB-65 and SMART-COP improved the predictive ability for adverse outcomes. Discussion: The findings suggest that NLR simultaneously reflects the intensity of systemic inflammatory response and the immunological alterations associated with aging, explaining its usefulness as a prognostic marker in lower respiratory tract diseases. Conclusions: The neutrophil-to-lymphocyte ratio was the blood biomarker that demonstrated the highest predictive value for risk stratification in older adults with lower respiratory tract diseases. Its accessibility, low cost, and availability through routine blood count testing support its use as a complementary tool for timely clinical decision-making.

References

Albán Poma, Y. F., Vintimilla Márquez, A. M., Naranjo Serrano, S. G., Chávez Marín, A. M., & Ordóñez Chacha, P. R. (2024). Asociación entre el índice neutrófilos/linfocitos y la mortalidad en pacientes con COVID-19 severo. Revista de la Facultad de Ciencias Médicas de la Universidad de Cuenca, 42(2), 21-29. https://doi.org/10.18537/RFCM.42.02.03

Carreras, M., Dasque, C., Stolar, M., Parodi, M. N., Barrios, R. N., Estramiana, Y., Gastaldi, M. V., Mouse, C., Presas, J. L., Marovelli, L., & Gandino, I. J. (2021). Importancia del índice neutrófilo-linfocito en su asociación con mortalidad en pacientes con COVID-19: Experiencia en un centro de salud en Argentina. Revista Chilena de Infectología, 38(6), 768-773. https://doi.org/10.4067/S0716-10182021000600768

Cortez, G. (2025). Correlación del índice neutrófilos/linfocitos y la severidad de la neumonía adquirida en la comunidad en pacientes del HGZ n° 50 del IMSS. [Tesis de especialidad]. Repositorio Nacional CONACYT.

Curbelo, J., Rajas, O., Arnalich, B., Galván-Román, J. M., Luquero-Bueno, S., Ortega-Gómez, M., et al. (2019). Estudio del porcentaje de neutrófilos y el cociente de neutrófilos-linfocitos como marcadores pronósticos en pacientes hospitalizados por neumonía adquirida en la comunidad. Archivos de Bronconeumología, 55(9), 472-477. https://doi.org/10.1016/j.arbres.2019.02.005

Del Carpio-Orantes, L., García-Méndez, S., & Hernández-Hernández, S. N. (2020). Índices neutrófilo/linfocito, plaqueta/linfocito e inmunidad/inflamación sistémica en pacientes con neumonía por COVID-19. Gaceta Médica de México, 156(6), 537-541. https://doi.org/10.24875/GMM.20000485

Díaz de León Hernández. (2025). Asociación entre el índice neutrófilo-linfocito con la mortalidad, en pacientes hospitalizados por neumonía adquirida en la comunidad en el Hospital General de Zona No. 2 del OOAD, Aguascalientes. [Tesis de especialidad]. Universidad Autónoma de Aguascalientes.

Escobar-Salinas, J. S., & Sobarzo-Vysokolan, P. M. B. (2022). Índice neutrófilo-linfocito como predictor de desarrollo de neumonía grave por SARS-CoV-2 en el Hospital Nacional, Itauguá. Revista Virtual de la Sociedad Paraguaya de Medicina Interna, 9(1), 55-61.

Fang, L., Zhu, J., & Fu, D. (2025). The prognostic significance of the NLR in individuals diagnosed with COPD: a meta-analysis. BMC Pulmonary Medicine, 25(206), 1-11. https://doi.org/10.1186/s12890-025-03677-y

Fu, Y., Wang, Y., Wang, Y., Mou, T., He, X., Wang, J., Xiong, A., Qing, B., Wu, D., & Li, G. (2024). Biomarkers NLR, PLR, SII for frequent COPD exacerbations. International Journal of Chronic Obstructive Pulmonary Disease, 19, 933-943. https://doi.org/10.2147/COPD.S452444

Gasmi, M., Torabinasab, K., Williams-Hooker, R., Marsigliante, S., & Muscella, A. (2026). The neutrophil-to-lymphocyte ratio as a marker of immunosenescence and COVID-19 outcomes in the elderly: A narrative review. Physiological Reports, 14, e70682. https://doi.org/10.14814/phy2.70682

Ghosh, A., Banerjee, A., Deka, P., Pandey, D. K., Sharma, D. J., & Batta, A. (2025). Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker of Disease Severity in Community-Acquired Pneumonia Among Hospitalized Patients From Northeast India. Cureus, 17(12), e98524. https://doi.org/10.7759/cureus.98524

Guzmán Velázquez, A. M., Morales Santaella, A. L., Flores López, I., & Marcial Cruz, D. (2025). Índice neutrófilo-linfocito como predictor de gravedad en pacientes con neumonía adquirida en la comunidad. Medicina Interna de México, 41(5), 268-274. https://doi.org/10.24245/mim.v71iMayo.10337

Huang, L., Weng, B., Wang, Y., Wang, M., Weng, J., Du, X., Ju, Y., Zhong, X., Tong, X., & Li, Y. (2025). The improved prediction value of NLR to pneumonia severity scores for mortality in the older people with CAP. BMC Geriatrics, 25(1), 485. https://doi.org/10.1186/s12877-025-06121-2

Kuikel, S., Pathak, N., Poudel, S., Thapa, S., Bhattarai, S. L., Chaudhary, G., & Pandey, K. R. (2022). Neutrophil–lymphocyte ratio as a predictor of adverse outcome in patients with community‐acquired pneumonia: A systematic review. Health Science Reports, 5(3), e630. https://doi.org/10.1002/hsr2.630

Landolfo Olivera, F. M., Russo, J., García, N., Ferri, E., Lloret, M. L., Gisbert, P., Fernández, M., Salvatore, A., & Salomón, S. E. (2023). Utilidad del Índice neutrófilo/linfocito en Neumonías adquiridas de la comunidad. Revista de Medicina de la Universidad, 19(2), 1-8. https://revistas.uncu.edu.ar/ojs3/index.php/rmu/article/view/7272

Pardal-Refoyo, J. L., & Pardal-Peláez, B. (2020). Anotaciones para estructurar una revisión sistemática. Revista ORL, 11(3), 157-175. https://doi.org/10.14201/orl.22941

Qureshi, M. M., Ashraf, M. N., Mariam, S., Kazmi, S. M. H., Habib, M. F., & Ali, W. (2025). Neutrophil-to-Lymphocyte Ratio in Chronic Obstructive Pulmonary Disease Exacerbators presenting to Emergency: A Marker of Disease Severity and Poor Outcomes. Pakistan Armed Forces Medical Journal, 75(Suppl-7), S1127-S1130. https://doi.org/10.51253/pafmj.v75iSUPPL-7.10784

Rivera-Sánchez, J., & González-Valdivia, F. (2024). Los pulmones del adulto mayor. En R. Carrillo-Esper & R. Cabello-Aguilera (Eds.), Medicina crítica en el adulto mayor (pp. 33-40). Alfil.

Rojas-Valles, E. U., Magaña-González, C. A., & Herrera-Barrios, M. T. (2023). ¿Los neutrófilos como células de defensa? Inmunobiología y fisiopatología en las enfermedades infecciosas respiratorias humanas. Neumología y Cirugía de Tórax, 82(3), 162-173. https://doi.org/10.35366/116815

Shusterman, E., Prozan, L., Ablin, J. N., Weiss-Meilik, A., Adler, A., Choshen, G., & Kehat, O. (2023). Neutrophil-to-lymphocyte ratio trend at admission predicts adverse outcome in hospitalized respiratory syncytial virus patients. Heliyon, 9(5), e16482. https://doi.org/10.1016/j.heliyon.2023.e16482