中性粒细胞与淋巴细胞比值预测脑静脉血栓形成的转归。

Neutrophil-to-lymphocyte Ratio Predicts the Outcome of Cerebral Venous Thrombosis.

机构信息

Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China.

出版信息

Curr Neurovasc Res. 2021;18(2):204-210. doi: 10.2174/1567202618666210726122310.

DOI:10.2174/1567202618666210726122310

PMID:34313199

Abstract

BACKGROUND

Increasing evidences suggest that Neutrophil-to-Lymphocyte Ratio (NLR) is an independent predictor of poor prognosis in patients with cardiovascular disease. However, the relationship between NLR and prognosis in patients with Cerebral Venous Thrombosis (CVT) has not been studied.

METHODS

Consecutive CVT patients from November 2011 through April 2019 were retrospectively identified. Poor outcome was defined as a modified Rankin Scale (mRS) of 3-6. Multivariate regression analysis was conducted to assess the relationship between total and differential leukocyte counts, NLR and clinical outcome in CVT patients. The Receiver Operating Characteristic (ROC) analysis was further performed to evaluate the ability to predict mortality, and subgroup analysis was conducted to explore the potential interaction effects.

RESULTS

A total of 360 CVT patients were included, and the median duration of follow-up was 9.0 months. Multivariate logistic regression analysis suggested that NLR value, as a continuous variable, was significantly associated with a high risk of poor outcome (adjusted odds ratio [OR]=1.06, 95% confidence intervals [CI] 1.01-1.11, P = 0.013) and mortality (adjusted OR = 1.08; 95% CI, 1.03-1.14; P = 0.002). Compared with the total and differential leukocyte counts, the best discriminating variable to predict the risk of mortality was NLR, and the area under the receiver operating curve was 0.81. The optimal cut-off value of NLR to predict mortality was 5.6 (sensitivity 84.2%, specificity 69.9%). Multivariate Cox regression analysis indicated that the mortality rate was significantly higher in patients with a high NLR level group (>5.6) (adjust hazard ratio=5.65, 95% CI 2.33-12.73, P<0.001). There was no potential heterogeneity in the further subgroup analysis across age (above vs. below 45 years old), sex, history of infections and pregnancy/postpartum, presence of coma and intracerebral hemorrhage.

CONCLUSION

Elevated NLR value is associated with a high risk of poor outcomes in CVT patients.

摘要

背景

越来越多的证据表明，中性粒细胞与淋巴细胞比值（NLR）是心血管疾病患者预后不良的独立预测因子。然而，NLR 与脑静脉血栓形成（CVT）患者的预后之间的关系尚未得到研究。

方法

回顾性纳入 2011 年 11 月至 2019 年 4 月期间的连续 CVT 患者。预后不良定义为改良 Rankin 量表（mRS）评分为 3-6。多变量回归分析用于评估 CVT 患者总白细胞和分类白细胞计数、NLR 与临床结局之间的关系。进一步进行受试者工作特征（ROC）分析以评估预测死亡率的能力，并进行亚组分析以探索潜在的交互效应。

结果

共纳入 360 例 CVT 患者，中位随访时间为 9.0 个月。多变量逻辑回归分析表明，NLR 值作为连续变量，与预后不良的高风险显著相关（调整后的优势比[OR]=1.06，95%置信区间[CI]1.01-1.11，P=0.013）和死亡率（调整后的 OR=1.08；95%CI，1.03-1.14；P=0.002）。与总白细胞和分类白细胞计数相比，预测死亡率的最佳鉴别变量是 NLR，ROC 曲线下面积为 0.81。预测死亡率的 NLR 最佳截断值为 5.6（敏感性 84.2%，特异性 69.9%）。多变量 Cox 回归分析表明，NLR 水平较高（>5.6）的患者死亡率显著更高（调整后的危险比=5.65，95%CI 2.33-12.73，P<0.001）。在进一步的亚组分析中，年龄（大于或小于 45 岁）、性别、感染和妊娠/产后史、昏迷和脑出血的存在等亚组之间没有潜在的异质性。