Kasapoğlu Umut Sabri, Olgun Yıldızeli Şehnaz, Arıkan Hüseyin, Erer Ayşen, Kabadayı Feyyaz, Yalçınkaya Erdem, Aslan Melek, Cimşit Nuri Çağatay, Eryüksel Emel, Karakurt Sait
Department of Chest Diseases and Intensive Care, Faculty of Medicine, Marmara University, Istanbul, Turkey.
Department of Radiology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
Tuberk Toraks. 2019 Sep;67(3):179-189. doi: 10.5578/tt.68519.
Identifying the prognostic factors for patients with acute pulmonary embolism (APE) play a critical role in determining of the treatment strategy and to reduce mortality. The aim of this study is to evaluate the prognostic value of Neutrophil to Lymphocyte Ratio (NLR) and compare NLR with other prognostic factors in APE.
We retrospectively examined 550 cases of acute pulmonary embolism diagnosed by spiral computed tomographic angiography. A receiver operating characteristics (ROC) curve was used to determine the sensitivity and specificity of parameters and the optimal cut-off value for predicting mortality. Significance of each prognostic factors selected by univariate analysis confirmed using Cox regression model.
Baseline NLR, Platelet to Lymphocyte Ratio (PLR), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), and D-dimer values respectively were found significantly high in patients who died within 30 days (p< 0.05). Patients with high-risk status and sPESI > 2 points had a significantly higher short-term mortality rate (p< 0.05). Short-time mortality was found significantly higher in patients with NLR > 7.3 (p< 0.05). Cox regression analysis indicated that patient risk status and sPESI score were independent prognostic factors (p< 0.05). However, NLR was not found as a predictor of mortality in APE (p> 0.05). After the subgroup analysis of the study, in patients without comorbid diseases NLR, patient’s risk status, sPESI score were found the predictor of mortality in APE (p< 0.05).
NLR maybe a useful prognostic factor for patients without comorbid diseases in short time of mortality in APE.
识别急性肺栓塞（APE）患者的预后因素对于确定治疗策略和降低死亡率起着关键作用。本研究的目的是评估中性粒细胞与淋巴细胞比值（NLR）的预后价值，并将NLR与APE的其他预后因素进行比较。
我们回顾性研究了550例经螺旋计算机断层血管造影诊断为急性肺栓塞的病例。采用受试者工作特征（ROC）曲线来确定参数的敏感性和特异性以及预测死亡率的最佳临界值。通过Cox回归模型确认单因素分析所选各预后因素的显著性。
在30天内死亡的患者中，基线NLR、血小板与淋巴细胞比值（PLR）、N末端脑钠肽前体（NT-proBNP）和D-二聚体值分别显著升高（p<0.05）。高危状态且简化肺栓塞严重程度指数（sPESI）>2分的患者短期死亡率显著更高（p<0.05）。NLR>7.3的患者短期死亡率显著更高（p<0.05）。Cox回归分析表明患者风险状态和sPESI评分是独立的预后因素（p<0.05）。然而，未发现NLR是APE患者死亡率的预测指标（p>0.05）。研究进行亚组分析后，在无合并症的患者中，发现NLR、患者风险状态、sPESI评分是APE患者死亡率的预测指标（p<0.05）。
对于无合并症的APE患者，在短期死亡率方面，NLR可能是一个有用的预后因素。
