Wang Yu, Yuan Miao, Ma Yao, Shao Congcong, Wang Yuan, Qi Mengyao, Ren Bincheng, Gao Dengfeng
Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
Department of Rheumatology and Immunology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
Front Cardiovasc Med. 2022 Apr 7;9:870176. doi: 10.3389/fcvm.2022.870176. eCollection 2022.
Peripheral differential leukocyte counts are accepted prognostic indicators in patients with acute myocardial infarction (AMI). Herein, we assessed the value of the admission (neutrophil+monocyte)/lymphocyte ratio (NMLR) in predicting in-hospital mortality in these patients.
Samples of patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database meeting the criteria were included. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value and the optimum cut-off value of admission NMLR. Univariate and multivariate Cox regression analyses and restricted cubic spline (RCS) were performed to determine and visualize the association between admission NMLR and in-hospital mortality. The Kaplan-Meier (KM) method was used to plot survival curves of two groups with different admission NMLR levels.
Samples in the non-survival group had higher admission NMLR values than samples in the survival group (12.11 [7.22-21.05] vs. 6.38 [3.96-11.25], < 0.05). The area under the ROC curve (AUROC) [0.707 (95% Confidence Interval, 0.677-0.737)] was significantly better than those of other indicators related to peripheral differential leukocyte counts, and the optimal cut-off value was 8.518. Cox regression analysis identified that higher admission NMLR was an independent risk factor for in-hospital mortality. RCS visualized the uptrend and the non-linear relationship between admission NMLR and in-hospital mortality (-value for non-linearity <0.05). The KM survival curve of the high admission NMLR group was significantly lower than that of the low admission NMLR group ( < 0.001), and the former was associated with an increased risk of in-hospital mortality compared to the latter (Hazard Ratio, 1.452; 95% Confidence Interval, 1.132-1.862; < 0.05).
An elevated admission NMLR is an independent predictor for high in-hospital mortality in patients with AMI. And it is superior to other leukocyte-related indexes.
外周血白细胞分类计数是急性心肌梗死（AMI）患者公认的预后指标。在此，我们评估了入院时（中性粒细胞+单核细胞）/淋巴细胞比值（NMLR）对这些患者院内死亡率的预测价值。
纳入重症监护医学信息数据库IV（MIMIC-IV）中符合标准的患者样本。绘制受试者工作特征（ROC）曲线，以探索入院时NMLR的预测价值和最佳截断值。进行单因素和多因素Cox回归分析以及限制性立方样条（RCS）分析，以确定并直观显示入院时NMLR与院内死亡率之间的关联。采用Kaplan-Meier（KM）法绘制不同入院NMLR水平两组患者的生存曲线。
非生存组样本的入院NMLR值高于生存组样本（12.11[7.22 - 21.05]对6.38[3.96 - 11.25]，<0.05）。ROC曲线下面积（AUROC）为[0.707（95%置信区间，0.677 - 0.737）]，显著优于其他外周血白细胞分类计数相关指标，最佳截断值为8.518。Cox回归分析确定，较高的入院NMLR是院内死亡的独立危险因素。RCS直观显示了入院时NMLR与院内死亡率之间的上升趋势和非线性关系（非线性检验P值<0.05）。高入院NMLR组的KM生存曲线显著低于低入院NMLR组（<0.001），与后者相比，前者院内死亡风险增加（风险比，1.452；95%置信区间，1.132 - 1.862；<0.05）。
入院时NMLR升高是AMI患者院内高死亡率的独立预测因素，且优于其他白细胞相关指标。
