中性粒细胞与淋巴细胞比值：院内心脏骤停患者的一种预后评估工具。
Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest.
作者信息
Patel Vishal H, Vendittelli Philip, Garg Rajat, Szpunar Susan, LaLonde Thomas, Lee John, Rosman Howard, Mehta Rajendra H, Othman Hussein
机构信息
Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States.
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44915, United States.
出版信息
World J Crit Care Med. 2019 Feb 21;8(2):9-17. doi: 10.5492/wjccm.v8.i2.9.
BACKGROUND
In-hospital cardiac arrest (IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation (ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio (NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.
AIM
To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.
METHODS
A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value (NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis (area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and 42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.
RESULTS
We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female. In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9 (range 0.6-46.5) compared with 8.9 (0.28-96) in non-survivors ( = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55 [odds ratio (OR) = 5.20, confidence interval (CI): 1.5-18.3, = 0.01], older age (OR = 1.03, CI: 1.00-1.07, = 0.05), and elevated serum lactate level (OR = 1.20, CI: 1.03-1.40, = 0.02) were independent predictors of death.
CONCLUSION
An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.
背景
院内心脏骤停（IHCA）预示着预后不良和出院生存率较低。白细胞介素-6、S-100蛋白和高敏C反应蛋白等预后标志物已被研究作为自主循环恢复（ROSC）后不良结局的预测指标；然而，这些变量并非常规实验室检查项目，且会产生额外费用，这使得它们在评估患者预后时难以纳入且吸引力较低。中性粒细胞与淋巴细胞比值（NLR）是许多心血管疾病、某些类型癌症和脓毒症不良预后的标志物。我们假设，NLR升高与IHCA患者包括出院时死亡率在内的不良结局相关。
目的
确定NLR对实现ROSC的IHCA患者的预后意义。
方法
对美国一家大型城市社区医院在一年期间按照高级心脏生命支持方案接受治疗的所有IHCA患者进行回顾性研究。根据患者的NLR值（NLR < 4.5或NLR≥4.5）将患者分为两组。该切点源自接受者操作特征曲线分析（曲线下面积 = 0.66），对预测IHCA后院内死亡具有73%的阳性预测值、82%的敏感性和42%的特异性。主要结局为30天内死亡或出院，以先发生者为准。
结果
我们回顾了153例患者，平均年龄为66.1±16.3岁；48%为女性。院内死亡率为65%。幸存者的NLR中位数为4.9（范围0.6 - 46.5），而非幸存者为8.9（0.28 - 96）（P = 0.001）。多变量逻辑回归模型显示，NLR高于4.55[比值比（OR） = 5.20，置信区间（CI）：1.5 - 18.3，P = 0.01]、年龄较大（OR = 1.03，CI：1.00 - 1.07，P = 0.05）以及血清乳酸水平升高（OR = 1.20，CI：1.03 - 1.40，P = 0.02）是死亡的独立预测因素。
结论
NLR≥4.5可能是IHCA患者死亡风险增加的有用标志物。
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