中性粒细胞百分比与白蛋白比值作为心源性休克患者全因死亡率的新预测指标。
The Neutrophil Percentage-to-Albumin Ratio as a New Predictor of All-Cause Mortality in Patients with Cardiogenic Shock.
机构信息
Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China.
Department of Gastroenterology, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing, 210002 Jiangsu, China.
出版信息
Biomed Res Int. 2020 Nov 26;2020:7458451. doi: 10.1155/2020/7458451. eCollection 2020.
BACKGROUND
Although the neutrophil percentage-to-albumin ratio (NPAR) has proven to be a robust systemic inflammation-based predictor of mortality in a wide range of diseases, the prognostic value of the NPAR in critically ill patients with cardiogenic shock (CS) remains unknown. This study aimed at investigating the association between the admission NPAR and clinical outcomes in CS patients using real-world data.
METHODS
Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included all-cause in-hospital, 30-day, and 365-day mortality in CS patients. First, the NPAR was analyzed as a continuous variable using restricted cubic spline Cox regression models. Second, X-tile analysis was used to calculate the optimal cut-off values for the NPAR and divide the cohort into three NPAR groups. Moreover, multivariable Cox regression analyses were used to assess the association of the NPAR groups with mortality.
RESULTS
A total of 891 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between the NPAR and in-hospital and 30-day mortality was observed (all values for nonlinear trend<0.001). According to the optimal cut-off values by X-tile, NPARs were divided into three groups: group I (NPAR < 25.3), group II (25.3 ≤ NPAR < 34.8), and group III (34.8 ≤ NPAR). Multivariable Cox analysis showed that higher NPAR was independently associated with increased risk of in-hospital mortality (group III vs. group I: hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.72-3.92, < 0.001), 30-day mortality (group III vs. group I: HR 2.42, 95% CI 1.65-3.54, < 0.001), and 365-day mortality (group III vs. group I: HR 6.80, 95% CI 4.10-11.26, < 0.001) in patients with CS.
CONCLUSIONS
Admission NPAR was independently associated with in-hospital, 30-day, and 365-day mortality in critically ill patients with CS.
背景
虽然中性粒细胞百分比与白蛋白比值（NPAR）已被证明是广泛疾病中死亡率的可靠全身炎症预测指标，但 NPAR 在伴有心源性休克（CS）的危重症患者中的预后价值尚不清楚。本研究旨在使用真实世界数据探讨入院时 NPAR 与 CS 患者临床结局之间的关系。
方法
本研究纳入了 Medical Information Mart for Intensive Care-III（MIMIC-III）数据库中诊断为 CS 的危重症患者。本研究的终点包括 CS 患者的全因住院、30 天和 365 天死亡率。首先，使用限制性立方样条 Cox 回归模型分析 NPAR 作为连续变量。其次，X-tile 分析用于计算 NPAR 的最佳截断值，并将队列分为三个 NPAR 组。此外，多变量 Cox 回归分析用于评估 NPAR 组与死亡率的关系。
结果
共纳入 891 例 CS 住院患者。NPAR 与住院和 30 天死亡率之间呈非线性关系（所有非线性趋势值均<0.001）。根据 X-tile 的最佳截断值，NPAR 分为三组：组 I（NPAR < 25.3）、组 II（25.3≤NPAR < 34.8）和组 III（34.8≤NPAR）。多变量 Cox 分析表明，较高的 NPAR 与住院死亡率增加独立相关（组 III 与组 I：风险比 [HR] 2.60，95%置信区间 [CI] 1.72-3.92，<0.001）、30 天死亡率（组 III 与组 I：HR 2.42，95%CI 1.65-3.54，<0.001）和 365 天死亡率（组 III 与组 I：HR 6.80，95%CI 4.10-11.26，<0.001）。
结论
入院时 NPAR 与伴有 CS 的危重症患者的住院、30 天和 365 天死亡率独立相关。
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