淋巴细胞与单核细胞比值可预测感染性休克肝硬化患者的死亡率。
Lymphocyte-to-monocyte ratio predicts mortality in cirrhotic patients with septic shock.
机构信息
Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
出版信息
Am J Emerg Med. 2021 Feb;40:70-76. doi: 10.1016/j.ajem.2020.11.071. Epub 2020 Dec 3.
INTRODUCTION
Patients with liver cirrhosis and septic shock have a significantly higher risk of mortality and morbidity compared with non-cirrhotic patients. The peripheral blood lymphocyte-to-monocyte ratio (LMR) can determine the prognosis of cirrhotic patients. Our study aimed to investigate the usefulness of LMR as a predictive marker of mortality risk in cirrhotic patients with septic shock.
METHODS
This single-center, retrospective case-control study included adult patients who visited the emergency department between January 1, 2018 and June 30, 2020 and diagnosed with liver cirrhosis and septic shock. They were divided into survivor and non-survivor groups according to their survival status at the 60-day follow-up. We used a Cox proportional hazards regression model to identify independent factors associated with mortality risk and tested the mortality discriminative ability of those factors using the area under a receiver operating characteristic curve.
RESULTS
A total of 93 patients were eligible for this study. Compared with the patients in the survivor group, those in the non-survivor group had significantly higher Child-Pugh (11 ± 2 vs. 9 ± 2, p < 0.001) and MELD scores (29 ± 6 vs. 22 ± 8, p < 0.001), higher serum international normalized ratio (1.7 vs.1.4, p = 0.03), bilirubin (6.0 vs. 3.3 mg/dL, p = 0.02), lactate (5.4 vs. 2.7 mmol/L, p < 0.01), creatinine (2.2 vs. 1.6 mg/dL, p = 0.04), higher neutrophil-to-lymphocyte ratio (13.0 vs. 10.3, p = 0.02), and lower LMR (1.1 vs. 2.3, p < 0.01). The LMR (adjusted hazard ratio [aHR] = 1.54, p = 0.01) and lactate (aHR = 1.03, p < 0.01) were identified as independent predictive factors for mortality in the multivariate regression model. Furthermore, LMR (area under curve [AUC]: 0.87) revealed a superior discrimination ability in mortality prediction compared with the Child-Pugh (AUC: 0.72) and MELD (AUC: 0.76) scores.
CONCLUSIONS
The LMR can be used to predict mortality risk in cirrhotic patients with septic shock.
简介
肝硬化合并感染性休克的患者与非肝硬化患者相比，其死亡率和发病率明显更高。外周血淋巴细胞与单核细胞比值（LMR）可以确定肝硬化患者的预后。本研究旨在探讨 LMR 作为肝硬化合并感染性休克患者死亡风险预测指标的有效性。
方法
这是一项单中心、回顾性病例对照研究，纳入了 2018 年 1 月 1 日至 2020 年 6 月 30 日期间在急诊科就诊并被诊断为肝硬化合并感染性休克的成年患者。根据 60 天随访时的生存状态，将其分为存活组和非存活组。我们使用 Cox 比例风险回归模型来确定与死亡率相关的独立因素，并使用受试者工作特征曲线下面积来测试这些因素的死亡率判别能力。
结果
共有 93 名患者符合本研究条件。与存活组患者相比，非存活组患者的 Child-Pugh 评分（11 ± 2 与 9 ± 2，p < 0.001）和 MELD 评分（29 ± 6 与 22 ± 8，p < 0.001）更高，血清国际标准化比值（1.7 与 1.4，p = 0.03）、胆红素（6.0 与 3.3 mg/dL，p = 0.02）、乳酸（5.4 与 2.7 mmol/L，p < 0.01）、肌酐（2.2 与 1.6 mg/dL，p = 0.04）、中性粒细胞与淋巴细胞比值（13.0 与 10.3，p = 0.02）更高，LMR（1.1 与 2.3，p < 0.01）更低。在校正后的多变量回归模型中，LMR（调整后危险比[aHR] = 1.54，p = 0.01）和乳酸（aHR = 1.03，p < 0.01）被确定为死亡的独立预测因素。此外，LMR（曲线下面积[AUC]：0.87）在死亡率预测方面的判别能力优于 Child-Pugh 评分（AUC：0.72）和 MELD 评分（AUC：0.76）。
结论
LMR 可用于预测肝硬化合并感染性休克患者的死亡风险。
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