Han Yeji, Kim Soo Jung, Lee Su Hwan, Sim Yun Su, Ryu Yon Ju, Chang Jung Hyun, Shim Sung Shin, Kim Yookyung, Lee Jin Hwa
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
J Thorac Dis. 2018 Jan;10(1):339-346. doi: 10.21037/jtd.2017.12.65.
It is difficult to predict the prognosis of miliary tuberculosis (TB). We hypothesized that blood neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status to reflect independent prognostic significance in patients with miliary TB. The aim of this study is to investigate the relationship between NLR and outcome in miliary TB.
We retrospectively collected data from patients diagnosed with miliary TB in a tertiary referral hospital between January 1995 and January 2016.
A total of 96 patients were enrolled. Seventeen patients (18%) died during hospitalization due to miliary TB, and 9 (9%) died additionally during the 1-year follow-up period. Eighteen patients (19%) were diagnosed with acute respiratory distress syndrome (ARDS). In multiple logistic regression analyses, increased NLR was associated with ARDS [adjusted odds ratio, 1.15; 95% confidence interval (CI), 1.03-1.28]. By multivariate Cox regression analysis with adjustment of known prognostic factors including age, sex, body mass index, serum aspartate aminotransferase (AST), and hemoglobin, NLR was an independent predictor of in-hospital mortality [adjusted hazard ratio (aHR), 1.08; 95% CI, 1.03-1.13] and 1-year mortality (aHR, 1.08; 95% CI, 1.05-1.12).
Pre-treatment NLR at admission may be a useful biomarker for mortality and development of ARDS in patients with miliary TB.
粟粒性肺结核（TB）的预后难以预测。我们假设血液中性粒细胞与淋巴细胞比值（NLR）是炎症状态的一个指标，可反映粟粒性肺结核患者的独立预后意义。本研究旨在探讨NLR与粟粒性肺结核预后之间的关系。
我们回顾性收集了1995年1月至2016年1月在一家三级转诊医院被诊断为粟粒性肺结核患者的数据。
共纳入96例患者。17例患者（18%）因粟粒性肺结核在住院期间死亡，9例患者（9%）在1年随访期内额外死亡。18例患者（19%）被诊断为急性呼吸窘迫综合征（ARDS）。在多因素逻辑回归分析中，NLR升高与ARDS相关[调整后的优势比，1.15；95%置信区间（CI），1.03 - 1.28]。通过多因素Cox回归分析，并调整已知的预后因素，包括年龄、性别、体重指数、血清天冬氨酸转氨酶（AST）和血红蛋白，NLR是住院死亡率[调整后的危险比（aHR），1.08；95% CI，1.03 - 1.13]和1年死亡率（aHR，1.08；95% CI，1.05 - 1.12）的独立预测因素。
入院时治疗前的NLR可能是粟粒性肺结核患者死亡率和ARDS发生的有用生物标志物。
