Akilli Nazire Belgin, Yortanlı Mehmet, Mutlu Hüseyin, Günaydın Yahya Kemal, Koylu Ramazan, Akca Hatice Seyma, Akinci Emine, Dundar Zerrin Defne, Cander Basar
Department of Emergency Medicine, Konya Education and Research Hospital, Konya, Turkey.
Department of Emergency Medicine, Konya Education and Research Hospital, Konya, Turkey.
Am J Emerg Med. 2014 Dec;32(12):1476-80. doi: 10.1016/j.ajem.2014.09.001. Epub 2014 Sep 6.
The number of critically ill patients admitted to the emergency department increases daily. To decrease mortality, interventions and treatments should be conducted in a timely manner. It has been found that the neutrophil-lymphocyte ratio (NLR) is related to mortality in some disease groups, such as acute coronary syndrome and pulmonary emboli. The effect of the NLR on mortality is unknown in critically ill patients who are admitted to the emergency department. Our aim in this study is to evaluate the effect of the NLR on mortality in critically ill patients.
This study was planned as a prospective, observational cohort study. Patients who were admitted to the emergency department because they were critically ill and required the intensive care unit were included in the study. Demographic characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sepsis-related Organ Failure Assessment, Glasgow Coma Score, and NLR values were recorded upon emergency department admission. The patients were followed up for sepsis, ventilator-associated pneumonia, multiorgan failure, in-hospital mortality, and 6-month mortality.
The median (interquartile range) age of the 373 patients was 74 (190) years, and 54.4% were men. Neutrophil-lymphocyte ratio values were divided into quartiles, as follows: less than 3.48, 3.48 to 6.73, 6.74-13.6, and more than 13.6. There was no difference among these 4 groups regarding demographic characteristics, APACHE II score, Sepsis-related Organ Failure Assessment score, Glasgow Coma Score, and length of hospital stay (P>.05). In the multivariable Cox regression model, in-hospital mortality and 6-month mortality NLR were hazard ratio (HR), 1.63 (1.110-2.415; P=.01) and HR, 1.58 (1.136-2.213; P=.007), respectively, and APACHE II scores were detected as independent indicators.
The NLR is a simple, cheap, rapidly available, and independent indicator of short- and long-term mortalities. We suggest that the NLR can provide direction to emergency department physicians for interventions, particularly within a few hours after admission, in the critically ill patient group.
每日入住急诊科的危重症患者数量不断增加。为降低死亡率，应及时进行干预和治疗。已发现中性粒细胞与淋巴细胞比值（NLR）在某些疾病组（如急性冠脉综合征和肺栓塞）中与死亡率相关。NLR对入住急诊科的危重症患者死亡率的影响尚不清楚。本研究的目的是评估NLR对危重症患者死亡率的影响。
本研究计划为一项前瞻性观察队列研究。因病情危重且需要重症监护病房而入住急诊科的患者纳入本研究。在急诊科入院时记录人口统计学特征、急性生理与慢性健康状况评分系统II（APACHE II）、脓毒症相关器官功能衰竭评估、格拉斯哥昏迷评分和NLR值。对患者进行脓毒症、呼吸机相关性肺炎、多器官功能衰竭、住院死亡率和6个月死亡率的随访。
373例患者的年龄中位数（四分位间距）为74（190）岁，男性占54.4%。中性粒细胞与淋巴细胞比值分为四分位数，如下：小于3.48、3.48至6.73、6.74 - 13.6和大于13.6。这4组在人口统计学特征、APACHE II评分、脓毒症相关器官功能衰竭评估评分、格拉斯哥昏迷评分和住院时间方面无差异（P>0.05）。在多变量Cox回归模型中，住院死亡率和6个月死亡率的NLR危险比（HR）分别为1.63（1.110 - 2.415；P = 0.01）和HR 1.58（1.136 - 2.213；P = 0.007），且APACHE II评分被检测为独立指标。
NLR是短期和长期死亡率的一个简单、廉价、可快速获取的独立指标。我们建议NLR可为急诊科医生对危重症患者群体进行干预提供指导，尤其是在入院后的数小时内。
