严重出血患者中性粒细胞与淋巴细胞比值（NLR）的多机构分析：一种新的死亡率预测价值。
Multi-institutional analysis of neutrophil-to-lymphocyte ratio (NLR) in patients with severe hemorrhage: A new mortality predictor value.
作者信息
Duchesne Juan Carlos, Tatum Danielle, Jones Glenn, Davis Brandy, Robledo Rosemarie, DeMoya Marc, O'Keeffe Terence, Ferrada Paula, Jacome Tomas, Schroll Rebecca, Wlodarczyk Jordan, Prakash Priya, Smith Brian, Inaba Kenji, Khor Desmond, Duke Marquinn, Khan Mansoor
机构信息
From the Tulane School of Medicine (J.C.D.), New Orleans, Louisiana; North Oaks Shock Trauma (B.D., R.R., M.D.), Hammond, Louisiana; Our Lady of the Lake Regional Medical Center-Trauma Specialist Program (D.T., T.J.), Baton Rouge, Louisiana; Louisiana State University Health-Baton Rouge (G.J.), Baton Rouge, Louisiana; Massachusetts General Hospital (M.D.), Boston, Massachusetts; Banner University Medical Center-Tucson (T.O.), Tucson, Arizona; Department of Surgery (P.F.), Virginia Commonwealth University School of Medicine, Richmond, Virginia; Department of Surgery (R.S., J.W.), Tulane School of Medicine, New Orleans, Louisiana; Penn Medicine (P.P., B.S.), Philadelphia, Pennsylvania; Department of Surgery (K.I., D.K.), Keck School of Medicine of University of Southern California, Los Angeles, California; and St Mary's Hospital (M.K.), Imperial College Healthcare NHS Trust, Paddington, London, United Kingdom.
出版信息
J Trauma Acute Care Surg. 2017 Nov;83(5):888-893. doi: 10.1097/TA.0000000000001683.
BACKGROUND
The neutrophil/lymphocyte ratio (NLR) has been associated as a predictor for increased mortality in critically ill patients. We sought to determine the relationship between NLR and outcomes in adult trauma patients with severe hemorrhage requiring the initiation of massive transfusion protocol (MTP). We hypothesized that the NLR would be a prognostic indicator of mortality in this population.
METHODS
This was a multi-institutional retrospective cohort study of adult trauma patients (≥18 years) with severe hemorrhage who received MTP between November 2014 and November 2015. Differentiated blood cell counts obtained at days 3 and 10 were used to obtain NLR. Receiver operating characteristic (ROC) curve analysis assessed the predictive capacity of NLR on mortality. To identify the effect of NLR on survival, Kaplan-Meier (KM) survival analysis and Cox regression models were used.
RESULTS
A total of 285 patients with severe hemorrhage managed with MTP were analyzed from six participating institutions. Most (80%) were men, 57.2% suffered blunt trauma. Median (IQR) age, Injury Severity Score, and Glasgow Coma Scale were 35 (25-47), 25 (16-36), and 9 (3-15), respectively. Using ROC curve analysis, optimal NLR cutoff values of 8.81 at day 3 and 13.68 at day 10 were calculated by maximizing the Youden index. KM curves at day 3 (p = 0.05) and day 10 (p = 0.02) revealed an NLR greater than or equal to these cutoff values as a marker for increased in-hospital mortality. Cox regression models failed to demonstrate an NLR over 8.81 as predictive of in-hospital mortality at day 3 (p = 0.056) but was predictive for mortality if NLR was greater than 13.68 at day 10 (p = 0.036).
CONCLUSIONS
NLR is strongly associated with early mortality in patients with severe hemorrhage managed with MTP. Further research is needed to focus on factors that can ameliorate NLR in this patient population.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
中性粒细胞与淋巴细胞比值（NLR）已被认为是危重症患者死亡率增加的一个预测指标。我们试图确定NLR与需要启动大量输血方案（MTP）的成年创伤严重出血患者预后之间的关系。我们假设NLR将是该人群死亡率的一个预后指标。
方法
这是一项多机构回顾性队列研究，研究对象为2014年11月至2015年11月期间接受MTP的成年创伤严重出血患者（≥18岁）。使用第3天和第10天获得的分化血细胞计数来计算NLR。受试者操作特征（ROC）曲线分析评估了NLR对死亡率的预测能力。为了确定NLR对生存的影响，使用了Kaplan-Meier（KM）生存分析和Cox回归模型。
结果
对来自六个参与机构的285例接受MTP治疗的严重出血患者进行了分析。大多数（80%）为男性，57.2%为钝性创伤。年龄中位数（四分位间距）、损伤严重度评分和格拉斯哥昏迷量表分别为35（25 - 47）、25（16 - 36）和9（3 - 15）。通过ROC曲线分析，通过最大化约登指数计算出第3天的最佳NLR临界值为8.81，第10天为13.68。第3天（p = 0.05）和第10天（p = 0.02）的KM曲线显示，NLR大于或等于这些临界值是院内死亡率增加的一个标志。Cox回归模型未能证明第3天NLR超过8.81可预测院内死亡率（p = 0.056），但如果第10天NLR大于13.68，则可预测死亡率（p = 0.036）。
结论
NLR与接受MTP治疗的严重出血患者的早期死亡率密切相关。需要进一步研究关注可改善该患者群体NLR的因素。
证据水平
预后研究，III级。
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