Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland).
Department of Endocrinology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China (mainland).
Med Sci Monit. 2020 May 18;26:e922167. doi: 10.12659/MSM.922167.
BACKGROUND Inflammation plays an important part in the pathogenesis of cardiogenic shock (CGS). Whether the neutrophil-lymphocyte ratio (NLR), an integrated biomarker of inflammation, is associated with the outcome of CGS patients remains unknown. This retrospective cohort study was performed to identify the utility of using NLR among patients with CGS. MATERIAL AND METHODS Data were extracted from the MIMIC database. We applied smooth curve fitting to define the NLR cutoff values. The primary outcome was 30-day mortality. Cox proportional hazards models, subgroup analysis, and receiver operator characteristic (ROC) curve analysis were performed. RESULTS A total of 1470 CGS patients were extracted, among which 801 (54.5%) were men. The mean age of the population was 70.37 years. An inverse U-shaped relationship was observed between NLR and mortality in CGS patients, with the highest risk being at values ranging from 9.4 to 15. For the primary outcome of 30-day mortality, the adjusted HR (95% CI) values of the middle tertile (NLR 9.4-15) and the upper tertile (NLR >15) were 1.47 (1.14, 1.88) and 1.22 (0.94, 1.57) compared with the reference of lower tertile (NLR <9.4). ROC curve analysis showed that NLR had a more sensitive prognostic value in predicting 30-day mortality of CGS than the neutrophil or lymphocyte percentage alone (0.660 vs. 0.540, 0.549). CONCLUSIONS An inverse U-shaped curve was presented between NLR and the mortality of CGS. NLR seemed to be a readily available and independent prognostic biomarker for patients with CGS. The prognostic value of NLR was more sensitive than the neutrophil or lymphocyte percentage alone, but not as good as SOFA or SAPSII score.
炎症在心肌梗死所致心源性休克（CGS）的发病机制中起着重要作用。中性粒细胞-淋巴细胞比值（NLR）作为炎症的综合生物标志物，与 CGS 患者的预后是否相关尚不清楚。本回顾性队列研究旨在确定 NLR 在 CGS 患者中的应用价值。
数据来自 MIMIC 数据库。我们应用平滑曲线拟合来定义 NLR 的截断值。主要结局是 30 天死亡率。进行 Cox 比例风险模型、亚组分析和受试者工作特征（ROC）曲线分析。
共提取了 1470 例 CGS 患者，其中 801 例（54.5%）为男性。人群的平均年龄为 70.37 岁。在 CGS 患者中，NLR 与死亡率之间呈反 U 型关系，风险最高的是 NLR 值在 9.4 到 15 之间的范围。对于 30 天死亡率的主要结局，中三分位（NLR 9.4-15）和上三分位（NLR>15）的调整后 HR（95%CI）值分别为 1.47（1.14，1.88）和 1.22（0.94，1.57），与 NLR<9.4 的参考值相比。ROC 曲线分析表明，与单独的中性粒细胞或淋巴细胞百分比相比，NLR 对预测 CGS 30 天死亡率具有更高的敏感性（0.660 比 0.540，0.549）。
NLR 与 CGS 死亡率之间呈反 U 型曲线关系。NLR 似乎是 CGS 患者一种易于获得且独立的预后生物标志物。NLR 的预后价值比单独的中性粒细胞或淋巴细胞百分比更敏感，但不如 SOFA 或 SAPSII 评分。
