Soulaiman Soulaiman Elias, Dopa Dalal, Raad Al-Batool T, Hasan Walaa, Ibrahim Niyazi, Hasan Al-Ykzan, Sulaiman Hussam Aldin, Darwich Moufid
Department of Hematology and Bone Marrow Transplantation, Tishreen Hospital, Damascus, Syria.
Department of Laboratory, Tishreen Hospital, Damascus, Syria.
Int J Emerg Med. 2020 Feb 4;13(1):5. doi: 10.1186/s12245-020-0266-3.
Although the association of neutrophil to lymphocyte ratio (NLR) with mortality in trauma patients has recently been shown, there is a paucity of research on the association with other outcomes. Recent studies suggest that the NLR has a predictive value of mortality in trauma patients during various times of admission. This study aimed to determine the prognostic impact of NLR at the presentation in critically ill trauma patients.
A retrospective cohort study of adult trauma patients between July 2017 and November 2017 in Tishreen Hospital. All patients who had arrived at the emergency department with multi-trauma injury within the age category (14-80 years) were included in this analysis. The prophetical capability of NLR on mortality was assessed by the receiver operative characteristics (ROC) curve. To identify the impact of the NLR on survival, a separate log-rank test was used. Multivariable Cox proportional hazard modeling was used to identify independent predictors of mortality.
Throughout the time of the study, 566 patients met the inclusion criteria. Of these, 98.8% were male, 75.8% sustained penetrating trauma, and median age [IQR25-IQR75] was 26 [23-32]. Ninety-seven patients (17.1%) had major trauma, with an Injury Severity Score (ISS) ≥ 15. Using the ROC curve analyses hospitalization day 1, optimal NLR cutoff values of 4.00 were calculated by maximizing the Youden index. Kaplan-Meier curves revealed an NLR greater than or equal to these cutoff values as a marker for increased in-hospital mortality (p = 0.020, log-rank test). The Cox regression model demonstrated significant collinearity among the predictive variables (all VIF results < 2). Only ISS > 15 has a significant statistical relation with elevated NLR on day 1 (p = 0.010).
Elevated NLR on day 1 has high predictive power for overall survival during the first 30 days after trauma, but it was not independent of other factors.
尽管近期研究表明中性粒细胞与淋巴细胞比值（NLR）与创伤患者的死亡率有关，但关于其与其他预后指标关系的研究却很少。近期研究表明，NLR对创伤患者在入院不同时间段的死亡率具有预测价值。本研究旨在确定NLR在危重症创伤患者就诊时的预后影响。
对2017年7月至2017年11月在提什林医院的成年创伤患者进行一项回顾性队列研究。所有年龄在14至80岁之间因多发伤到达急诊科的患者均纳入本分析。通过受试者工作特征（ROC）曲线评估NLR对死亡率的预测能力。为确定NLR对生存的影响，采用了单独的对数秩检验。多变量Cox比例风险模型用于确定死亡率的独立预测因素。
在整个研究期间，566例患者符合纳入标准。其中，98.8%为男性，75.8%为穿透伤，中位年龄[四分位间距25 - 四分位间距75]为26岁[23 - 32岁]。97例患者（17.1%）为重伤，损伤严重程度评分（ISS）≥15。通过ROC曲线分析住院第1天，通过最大化约登指数计算出最佳NLR临界值为4.00。Kaplan - Meier曲线显示，NLR大于或等于这些临界值是院内死亡率增加的标志物（p = 0.020，对数秩检验）。Cox回归模型显示预测变量之间存在显著共线性（所有方差膨胀因子结果<2）。仅ISS>15与第1天NLR升高有显著统计学关系（p = 0.010）。
创伤后第1天NLR升高对创伤后前30天的总体生存具有较高预测能力，但它并非独立于其他因素。
