Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, Nanchang, Jiangxi, China.
Department of Intensive Care Unit, The First Affiliated Hospital of Nanchang University, Medical Department of Nanchang University, Nanchang, Jiangxi, China.
J Clin Lab Anal. 2022 Jan;36(1):e24136. doi: 10.1002/jcla.24136. Epub 2021 Nov 25.
Free-wall rupture (FWR) has a high mortality rate. We aimed to find sensitive predictive indicators to identify high-risk FWR patients by exploring the predictive values of neutrophil percentage-to-albumin ratio (NPAR) and monocyte-to-lymphocyte ratio (MLR) on patients with acute myocardial infarction (AMI).
76 FWR patients with AMI were collected, and then 228 non-CR patients with AMI were randomly selected (1:3 ratio) in this retrospective study. The independent influencing factors of FWR were evaluated by univariate and multivariate logistic regression analysis. The receiver-operating characteristic (ROC) curve analysis was applied to evaluate the predictive value of NPAR and MLR for FWR.
According to the results of multivariate logistic regression analysis, emergency percutaneous coronary intervention (PCI) (OR = 0.27, 95% CI: 0.094-0.751, p = 0.012), angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) treatment (OR = 0.17, 95% CI: 0.044-0.659, p = 0.010), NPAR (OR = 2.69, 95% CI: 1.031-7.044, p = 0.043), and MLR (OR = 5.99, 95% CI: 2.09-17.168, p = 0.001) were the influencing factors of the FWR patients with AMI, independently. Additionally, the NPAR and MLR were the predictors of FWR patients, with AUC of 0.811 and 0.778, respectively (both p < 0.001).
In summary, the emergency PCI and ACEI/ARB treatment were independent protective factors for FWR patients with AMI, while the increase of MLR and NPAR were independent risk factors. What's more, NPAR and MLR are good indicators for predicting FWR.
游离壁破裂（FWR）的死亡率很高。我们旨在通过探索中性粒细胞百分比与白蛋白比值（NPAR）和单核细胞与淋巴细胞比值（MLR）对急性心肌梗死（AMI）患者的预测价值，找到识别高危 FWR 患者的敏感预测指标。
本回顾性研究共纳入 76 例 FWR 合并 AMI 患者，并按 1:3 比例随机选取 228 例非 CR 合并 AMI 患者。采用单因素和多因素 logistic 回归分析评估 FWR 的独立影响因素。采用受试者工作特征（ROC）曲线分析评估 NPAR 和 MLR 对 FWR 的预测价值。
根据多因素 logistic 回归分析的结果，急诊经皮冠状动脉介入治疗（PCI）（OR=0.27，95%CI：0.094-0.751，p=0.012）、血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）治疗（OR=0.17，95%CI：0.044-0.659，p=0.010）、NPAR（OR=2.69，95%CI：1.031-7.044，p=0.043）和 MLR（OR=5.99，95%CI：2.09-17.168，p=0.001）是 AMI 合并 FWR 患者的独立影响因素。此外，NPAR 和 MLR 是 FWR 患者的预测因子，AUC 分别为 0.811 和 0.778（均 p<0.001）。
综上所述，急诊 PCI 和 ACEI/ARB 治疗是 AMI 合并 FWR 患者的独立保护因素，而 MLR 和 NPAR 的增加是独立的危险因素。此外，NPAR 和 MLR 是预测 FWR 的良好指标。
