Wang Ying, Ju Mohan, Chen Cuicui, Yang Dong, Hou Dongni, Tang Xinjun, Zhu Xiaodan, Zhang Donghui, Wang Lilin, Ji Shimeng, Jiang Jinjun, Song Yuanlin
Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai 200032, China.
Department of Pulmonary Medicine, Huashan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai 200032, China.
J Thorac Dis. 2018 Jan;10(1):273-282. doi: 10.21037/jtd.2017.12.131.
Acute respiratory distress syndrome (ARDS) is the leading cause of high mortality in intensive care units (ICUs) worldwide. An effective marker for prognosis in ARDS is particularly important given the absence of effective treatment strategies aside from small tidal volume ventilation. Previous studies identified an association between the neutrophil-to-lymphocyte ratio (NLR) and prognosis in critical patients. In this study, we explored the prognostic and predictive value of the NLR in ARDS patients.
We retrospectively included 275 ARDS patients treated at a single institute from 2008 to 2015. After excluding patients with chronic lung disease, acute myocardial infarction and missing data, 247 patients were ultimately included in the analysis. Clinical characteristics and experimental test data, including the NLR, were collected from medical records at 24 hours after the ARDS diagnosis. Independent prognostic factors were determined by multivariate Cox regression analysis. Subgroup stratification was performed according to different factors, and the continuous factors were divided according to the median values.
The NLR in survivors was significantly lower than that in non-survivors (P<0.001). We took the median NLR value as the cut-off point and further divided all patients into a high NLR group (NLR >14) and a low NLR group (NLR ≤14). We found that an NLR >14 was associated with a shorter overall survival (OS) (P=0.005). In the multivariate Cox regression model, we further identified an NLR >14 as an independent prognostic factor for OS [hazard ratio (HR) 1.532, (95% CI, 1.095-2.143), P=0.013]. Subgroup analysis showed that the prognostic value of the NLR was higher in hypertensive patients (P=0.009) and in patients with low red blood cell specific volume (P=0.013), high sodium (P=0.002) and high creatinine levels (P=0.017).
The NLR is potentially a predictive prognostic biomarker in ARDS patients.
急性呼吸窘迫综合征（ARDS）是全球重症监护病房（ICU）高死亡率的主要原因。鉴于除小潮气量通气外缺乏有效的治疗策略，ARDS预后的有效标志物尤为重要。既往研究发现中性粒细胞与淋巴细胞比值（NLR）与危重症患者的预后相关。在本研究中，我们探讨了NLR在ARDS患者中的预后及预测价值。
我们回顾性纳入了2008年至2015年在单中心接受治疗的275例ARDS患者。排除患有慢性肺病、急性心肌梗死及数据缺失的患者后，最终247例患者纳入分析。从ARDS诊断后24小时的病历中收集临床特征及实验检测数据，包括NLR。通过多因素Cox回归分析确定独立预后因素。根据不同因素进行亚组分层，连续因素根据中位数进行划分。
幸存者的NLR显著低于非幸存者（P<0.001）。我们将NLR中位数作为切点，进一步将所有患者分为高NLR组（NLR>14）和低NLR组（NLR≤14）。我们发现NLR>14与总生存期（OS）缩短相关（P=0.005）。在多因素Cox回归模型中，我们进一步确定NLR>14是OS的独立预后因素[风险比（HR）1.532，（95%CI，1.095-2.143），P=0.013]。亚组分析显示，NLR在高血压患者（P=0.009）、红细胞比容低（P=0.013）、高钠（P=0.002）和高肌酐水平（P=0.017）患者中的预后价值更高。
NLR可能是ARDS患者的预测性预后生物标志物。
