Rivera Núñez M A, Rodríguez Gijón L, Tung Chen Y, Martí de Gracia M, Buitrago Weiland G, Díez Tascón A
Department of emergency medicine, Hospital Universitario de La Paz, Madrid, Spain.
Department of emergency radiology, Hospital Universitario de La Paz, Madrid, Spain.
Emerg Radiol. 2019 Oct;26(5):515-521. doi: 10.1007/s10140-019-01699-8. Epub 2019 Jun 17.
To assess the usefulness of the neutrophil-to-lymphocyte ratio (NLR) as a predictive factor of acute mesenteric ischemia (AMI) in patients presenting at the emergency department (ED) with acute abdominal pain.
This is a retrospective case-control study of patients older than 16 years admitted to the ED with acute abdominal pain with CT and histologic confirmation. The study group corresponded to patients with abdominal CT with radiological signs of AMI. The control group corresponded to patients with non-AMI findings in abdominal CT. Association measurements of NLR with radiological signs were compared with a paired-sample t test, and multivariate regression performed to analyze potential correlations. To assess the diagnosis capacity of NLR, ROC curves were calculated.
A total of 61 patients were included (32 cases and 29 controls). The cases of AMI showed higher mortality (43.8% vs 6.9%, p < 0.01) and higher NLR on the limit of statistical significance (13.8 vs 8.7, p = 0.053). Patients with AMI due to occlusion of the superior mesenteric artery (SMA) showed a higher NLR (8.3 vs 22.3, p < 0.001). The area under the curve (AUC) of the NLR for AMI due to occlusion of the SMA was 0.88 (95% CI 0.7-1.0, p = 0.001). No patient with NLR < 5 presented AMI due to occlusion of the SMA. An NLR of 12.8 showed a sensitivity of 92% and a specificity of 74% for AMI due to occlusion of SMA.
The NLR is a useful parameter of AMI of arterial origin due to occlusion of the SMA; it can help the clinician to raise suspicion of this diagnosis and the interpreting radiologist in the acquisition protocol for the CT study and would alert for an early surgical treatment.
评估中性粒细胞与淋巴细胞比值（NLR）作为急诊科（ED）以急性腹痛就诊患者急性肠系膜缺血（AMI）预测因素的有效性。
这是一项对16岁以上因急性腹痛入住ED且经CT和组织学确诊的患者进行的回顾性病例对照研究。研究组为腹部CT有AMI放射学征象的患者。对照组为腹部CT无AMI表现的患者。采用配对样本t检验比较NLR与放射学征象的关联测量值，并进行多因素回归分析潜在相关性。为评估NLR的诊断能力，计算ROC曲线。
共纳入61例患者（32例病例和29例对照）。AMI病例显示死亡率更高（43.8%对6.9%，p<0.01），且NLR在统计学意义临界值上更高（13.8对8.7，p = 0.053）。因肠系膜上动脉（SMA）闭塞导致AMI的患者NLR更高（8.3对22.3，p<0.001）。SMA闭塞导致AMI的NLR曲线下面积（AUC）为0.88（95%CI 0.7 - 1.0，p = 0.001）。NLR<5的患者均未因SMA闭塞出现AMI。NLR为12.8时，对SMA闭塞导致的AMI敏感性为92%，特异性为74%。
NLR是SMA闭塞所致动脉源性AMI的有用参数；它可帮助临床医生提高对此诊断的怀疑，也有助于CT检查解读放射科医生在采集方案中做出判断，并提醒早期手术治疗。
