中性粒细胞/淋巴细胞比值可预测慢性阻塞性肺疾病急性加重患者无创机械通气失败：一项回顾性观察性研究。

The Neutrophil/Lymphocyte Ratio Could Predict Noninvasive Mechanical Ventilation Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study.

机构信息

Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.

Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China.

出版信息

Int J Chron Obstruct Pulmon Dis. 2021 Aug 5;16:2267-2277. doi: 10.2147/COPD.S320529. eCollection 2021.

DOI:10.2147/COPD.S320529

PMID:34385816

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8353100/

Abstract

PURPOSE

To determine the effectiveness of neutrophil/lymphocyte ratio (NLR), compared to traditional inflammatory markers, for predicting noninvasive mechanical ventilation (NIMV) failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.

PATIENTS AND METHODS

We conducted this retrospective observational study including 212 AECOPD patients who required NIMV during hospitalization from January 2015 to December 2020 in the department of respiratory and critical care medicine of Beijing Chao-Yang Hospital (west campus). We reviewed the medical record to determine if NIMV succeeded or failed for each patient, and compared NLR with traditional markers (leukocyte, C-reactive protein [CRP] and procalcitonin [PCT]) between NIMV failure and NIMV success group. Receiver-operating characteristic (ROC) curve and multivariate logistic regression analysis were used to assess the accuracy of these markers for predicting NIMV failure.

RESULTS

A total of 38 (17.9%) patients experienced NIMV failure. NLR was a more sensitive biomarker to predict NIMV failure (AUC, 0.858; 95% CI 0.785-0.931) than leukocyte counts (AUC, 0.723; 95% CI 0.623-0.823), CRP (AUC, 0.670; 95% CI 0.567-0.773) and PCT (AUC, 0.719; 95% CI 0.615-0.823). There was statistically positive correlation between NLR and leukocytes count (r=0.35, p<0.001), between NLR and CRP (r=0.258, p<0.001), between NLR and PCT (r=0.306, p<0.001). The cutoff value of NLR to predict NIMV failure was 8.9 with sensitivity 0.688, specificity 0.886 and diagnostic accuracy 0.868. NLR>8.9 (odds ratio, 10.783; 95% CI, 2.069-56.194; P=0.05) was an independent predictor of NIMV failure in the multivariate logistic regression model.

CONCLUSION

NLR may be an effective marker for predicting NIMV failure in AECOPD patients, and the patients with NLR>8.9 should be handled with caution since they are at higher risk of NIMV failure and require intubation. Further study with a larger sample size and with more data is necessary to confirm our study.

摘要

目的

确定中性粒细胞/淋巴细胞比值（NLR）与传统炎症标志物相比，在预测慢性阻塞性肺疾病急性加重（AECOPD）患者无创机械通气（NIMV）失败中的有效性。

方法

我们进行了这项回顾性观察性研究，纳入了 2015 年 1 月至 2020 年 12 月期间在北京朝阳医院（西院区）呼吸与危重症医学科住院需要 NIMV 的 212 例 AECOPD 患者。我们查阅病历以确定每位患者的 NIMV 是否成功或失败，并比较 NLR 与白细胞、C 反应蛋白（CRP）和降钙素原（PCT）等传统标志物在 NIMV 失败和 NIMV 成功组之间的差异。使用受试者工作特征（ROC）曲线和多变量逻辑回归分析评估这些标志物预测 NIMV 失败的准确性。

结果

共有 38 例（17.9%）患者发生 NIMV 失败。NLR 是一种比白细胞计数（AUC，0.723；95%CI，0.623-0.823）、CRP（AUC，0.670；95%CI，0.567-0.773）和 PCT（AUC，0.719；95%CI，0.615-0.823）更敏感的生物标志物，可预测 NIMV 失败（AUC，0.858；95%CI，0.785-0.931）。NLR 与白细胞计数之间存在统计学上的正相关关系（r=0.35，p<0.001），与 CRP 之间存在正相关关系（r=0.258，p<0.001），与 PCT 之间存在正相关关系（r=0.306，p<0.001）。预测 NIMV 失败的 NLR 截断值为 8.9，灵敏度为 0.688，特异性为 0.886，诊断准确性为 0.868。NLR>8.9（比值比，10.783；95%CI，2.069-56.194；P=0.05）是多变量逻辑回归模型中 NIMV 失败的独立预测因子。