Zhang Wei, Wang Yadan, Li Weijie, Wang Guizuo
Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China.
Ruibiao (Wuhan) Biotechnology Co. Ltd., Wuhan, China.
Front Med (Lausanne). 2021 May 14;8:636869. doi: 10.3389/fmed.2021.636869. eCollection 2021.
Two previous studies have shown that increased neutrophil to lymphocyte ratio (NLR) is associated with short-term prognosis in patients with acute respiratory distress syndrome (ARDS), but it is usually assessed as a single threshold value at baseline. We investigated the relationship between the baseline and the early change in NLR and 30-day mortality in patients with ARDS to evaluate the prognostic value of NLR baseline and NLR changes during the first 7 days after ICU admission. This is a retrospective cohort study, with all ARDS patients diagnosed according to the Berlin definition from the Medical Information Mart for Intensive Care III (MIMIC-III) database. We calculated the NLR by dividing the neutrophil count by the lymphocyte count. The multivariable logistic regression analysis was used to investigate the relationship between the baseline NLR and short-term mortality. Then the generalized additive mixed model was used to compare trends in NLR over time among survivors and non-survivors after adjusting for potential confounders. A total of 1164 patients were enrolled in our study. Multivariable logistic regression analysis showed that after adjusting for confounders, elevated baseline NLR was a significant risk factor predicting 30-day mortality (OR 1.02, 95%CI 1.01, 1.03, = 0.0046) and hospital mortality (OR 1.02, 95%CI 1.01, 1.03, = 0.0003). The result of the generalized additive mixed model showed that the NLR decreased in the survival group and increased in the non-survival group gradually within 7 days after ICU admission. The difference between the two groups showed a trend of increase gradually and the difference increased by an average of 0.67 daily after adjusting for confounders. We confirmed that there was a positive correlation between baseline NLR and short-term mortality, and we found significant differences in NLR changes over time between the non-survival group and the survival group. The early increase in NLR was associated with short-term mortality in ARDS patients.
此前两项研究表明，中性粒细胞与淋巴细胞比值（NLR）升高与急性呼吸窘迫综合征（ARDS）患者的短期预后相关，但通常将其评估为基线时的单一阈值。我们研究了ARDS患者基线NLR与早期变化以及30天死亡率之间的关系，以评估NLR基线及入住重症监护病房（ICU）后第1个7天内NLR变化的预后价值。这是一项回顾性队列研究，所有ARDS患者均根据重症监护医学信息数据库III（MIMIC-III）中的柏林定义进行诊断。我们通过中性粒细胞计数除以淋巴细胞计数来计算NLR。采用多变量逻辑回归分析来研究基线NLR与短期死亡率之间的关系。然后，在调整潜在混杂因素后，使用广义相加混合模型比较幸存者和非幸存者随时间变化的NLR趋势。我们的研究共纳入了1164例患者。多变量逻辑回归分析显示，在调整混杂因素后，基线NLR升高是预测30天死亡率（比值比1.02，95%置信区间1.01，1.03，P = 0.0046）和医院死亡率（比值比1.02，95%置信区间1.01，1.03，P = 0.0003）的显著危险因素。广义相加混合模型的结果显示，入住ICU后7天内，存活组的NLR逐渐下降，非存活组的NLR逐渐升高。两组之间的差异呈逐渐增加的趋势，在调整混杂因素后，差异平均每天增加0.67。我们证实基线NLR与短期死亡率之间存在正相关，并且发现非存活组和存活组随时间变化的NLR存在显著差异。ARDS患者早期NLR升高与短期死亡率相关。
