中性粒细胞-淋巴细胞比值对老年内科患者谵妄的预测作用：一项前瞻性队列研究。
Neutrophil-lymphocyte ratio as a predictor of delirium in older internal medicine patients: a prospective cohort study.
机构信息
Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China.
Department of Neurology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China.
出版信息
BMC Geriatr. 2021 May 25;21(1):334. doi: 10.1186/s12877-021-02284-w.
BACKGROUNDS
Delirium is a common neuropsychiatric syndrome in older hospitalized patients. Previous studies have suggested that inflammation and oxidative stress contribute to the pathophysiology of delirium. However, it remains unclear whether neutrophil-lymphocyte ratio (NLR), an indicator of systematic inflammation, is associated with delirium. This study aimed to investigate the value of NLR as an independent risk factor for delirium among older hospitalized patients.
METHODS
We conducted a prospective study of 740 hospitalized patients aged ≥ 70 years in the geriatric ward of West China Hospital of Sichuan University. Neutrophil and lymphocyte counts were collected within 24 h after hospital admission. Delirium was assessed on admission and every 48 h thereafter. We used the receiver operating characteristic analysis to assess the ability of the NLR for predicting delirium. The optimal cut-point value of the NLR was determined based on the highest Youden index (sensitivity + specificity - 1). Patients were categorized according to the cut-point value and quartiles of NLR, respectively. We then used logistic regression to identify the unadjusted and adjusted associations between NLR as a categorical variable and delirium.
RESULTS
The optimal cut-point value of NLR for predicting delirium was 3.626 (sensitivity: 75.2 %; specificity: 63.4 %; Youden index: 0.386). The incidence of delirium was significantly higher in patients with NLR > 3.626 than NLR ≤ 3.626 (24.5 % vs. 5.8 %; P < 0.001). Significantly fewer patients in the first quartile of NLR experienced delirium than in the third (4.3 % vs. 20.0 %; P < 0.001) and fourth quartiles of NLR (4.3 % vs. 24.9 %; P < 0.001). Results from the multivariable logistic regression models showed that NLR was independently associated with delirium.
CONCLUSIONS
NLR is a simple and practical marker that can predict the development of delirium in older internal medicine patients.
背景
谵妄是老年住院患者中常见的神经精神综合征。先前的研究表明，炎症和氧化应激与谵妄的病理生理学有关。然而，中性粒细胞与淋巴细胞比值（NLR）作为系统性炎症的指标是否与谵妄有关尚不清楚。本研究旨在探讨 NLR 是否可作为老年住院患者谵妄的独立危险因素。
方法
我们对四川大学华西医院老年病房的 740 名年龄≥70 岁的住院患者进行了前瞻性研究。入院后 24 小时内采集中性粒细胞和淋巴细胞计数。入院时和此后每 48 小时评估一次谵妄。我们使用受试者工作特征分析来评估 NLR 预测谵妄的能力。根据最高 Youden 指数（灵敏度+特异性-1）确定 NLR 的最佳截断值。根据 NLR 的截断值和四分位数对患者进行分类。然后，我们使用逻辑回归来确定 NLR 作为分类变量与谵妄之间的未经调整和调整关联。
结果
NLR 预测谵妄的最佳截断值为 3.626（灵敏度：75.2%；特异性：63.4%；Youden 指数：0.386）。 NLR>3.626的患者发生谵妄的比例明显高于 NLR≤3.626的患者（24.5%比 5.8%；P<0.001）。 NLR 第一四分位数的患者发生谵妄的比例明显低于 NLR 第三（4.3%比 20.0%；P<0.001）和第四四分位数（4.3%比 24.9%；P<0.001）。多变量逻辑回归模型的结果表明，NLR 与谵妄独立相关。
结论
NLR 是一种简单实用的标志物，可预测老年内科患者谵妄的发生。
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