The Graduate School of Fujian Medical University, Fuzhou, Fujian 350001, China.
Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China.
Chin Med J (Engl). 2020 Dec 24;134(6):682-689. doi: 10.1097/CM9.0000000000001304.
Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients.
We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed.
POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P < 0.001). Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors, including the age, World Federation of Neurosurgical Societies (WFNS) grade, endovascular treatment, and ventilator use. And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR (NLR vs. WFNS grade × NLR, P = 0.011).
Regardless of good or poor WNFS grade, patients having NLR >10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.
尽管已经研究了多种与动脉瘤夹闭或栓塞后肺炎（术后肺炎[POP]）相关的风险因素，但动脉瘤性蛛网膜下腔出血（aSAH）患者的 POP 预测模型仍未得到很好的建立。因此，本研究旨在评估入院中性粒细胞与淋巴细胞比值（NLR）预测 aSAH 患者发生 POP 的可行性。
我们评估了 711 例纳入前瞻性观察性研究的 aSAH 患者，并收集了入院时的血细胞计数数据。我们分析了这些患者的可用人口统计学和基线变量，并使用 Cox 回归分析了这些因素与 POP 的相关性。在筛选出与预后相关的因素后，进一步评估了这些因素对 POP 的预测价值。
在该队列中，219 例（30.4%）患者发生了 POP。发生 POP 的患者 NLR 明显高于未发生 POP 的患者（14.11±8.90 比 8.80±5.82，P<0.001）。多变量分析显示，在校正可能的混杂因素后，NLR 仍然是与 aSAH 后 POP 相关的独立显著因素，包括年龄、世界神经外科学会（WFNS）分级、血管内治疗和呼吸机使用。并且，在 WFNS 分级与 NLR 联合后，NLR 的预测价值显著增加（NLR 比 WFNS 分级×NLR，P=0.011）。
无论 WFNS 分级好坏，NLR>10 的患者的 POP 生存率明显低于 NLR≤10 的患者。入院时的 NLR 可能有助于预测 aSAH 患者的 POP。
