中性粒细胞与淋巴细胞比值与急性呼吸窘迫综合征患者有创机械通气需求和时间的相关性：一项回顾性研究。
The Neutrophil-to-Lymphocyte Ratio is Associated with the Requirement and the Duration of Invasive Mechanical Ventilation in Acute Respiratory Distress Syndrome Patients: A Retrospective Study.
机构信息
Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Department of Emergency and Critical Care Medicine, Dushu Lake Hospital Affiliated to Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China.
出版信息
Can Respir J. 2022 Jul 16;2022:1581038. doi: 10.1155/2022/1581038. eCollection 2022.
BACKGROUND
Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality and most ARDS patients require ventilatory support. Applying appropriate ventilation strategies based on patients' individual situations has a direct impact upon patients' outcome. The neutrophil-to-lymphocyte ratio (NLR) has been shown to predict the early requirement of invasive mechanical ventilation (IMV) in patients with coronavirus disease 2019 (COVID-19). Our study aimed to investigate the relationship between baseline NLR and IMV in ARDS.
METHODS
A retrospective study was performed on patients who were diagnosed with ARDS using the Berlin definition and admitted to the First Affiliated Hospital of Soochow University from 2017 to 2022. Clinical data within 24 h after the ARDS diagnosis were collected from the medical record system. Based on the ventilation strategies during hospitalization, patients were divided into three groups and their clinical characteristics were compared. Furthermore, logistic regression analysis was used to screen the independent risk factors for IMV. STROBE checklist was used for this manuscript.
RESULTS
520 ARDS patients were included and the median NLR value in IMV group was significantly higher than that of other groups ( < 0.001). NLR was significantly associated with the requirement of IMV in ARDS patients (OR, 1.042; 95% CI, 1.025-1.060; < 0.001), other independent risk factors included PaO/FiO, Hb, lactate, and use of vasoactive drugs (all < 0.05). Moreover, we found that the duration of IMV was longer in patients with high NLR (8[IQR, 3-13], 10[IQR, 6-16], respectively, =0.025).
CONCLUSIONS
Our results revealed that high baseline NLR level was significantly correlated with an increased risk of IMV in patients with ARDS. Furthermore, higher NLR was associated with prolonged duration of IMV in patients with ARDS.
背景
急性呼吸窘迫综合征（ARDS）与院内高死亡率相关，大多数 ARDS 患者需要通气支持。根据患者的个体情况应用适当的通气策略对患者的预后有直接影响。中性粒细胞与淋巴细胞比值（NLR）已被证明可预测 2019 年冠状病毒病（COVID-19）患者早期需要有创机械通气（IMV）。我们的研究旨在探讨 ARDS 患者基线 NLR 与 IMV 的关系。
方法
采用回顾性研究方法，收集 2017 年至 2022 年苏州大学第一附属医院符合柏林定义的 ARDS 患者的临床资料。收集 ARDS 诊断后 24 h 内的病历系统中的临床数据。根据住院期间的通气策略，将患者分为三组，比较其临床特征。此外，采用 logistic 回归分析筛选 IMV 的独立危险因素。本研究报告遵循 STROBE 清单。
结果
共纳入 520 例 ARDS 患者，IMV 组 NLR 值中位数明显高于其他两组（<0.001）。NLR 与 ARDS 患者需要 IMV 显著相关（OR，1.042；95%CI，1.025-1.060；<0.001），其他独立危险因素包括 PaO/FiO、Hb、乳酸和血管活性药物的使用（均<0.05）。此外，我们发现 NLR 较高的患者 IMV 持续时间较长（8[IQR，3-13]、10[IQR，6-16]，=0.025）。
结论
我们的研究结果表明，基线 NLR 水平较高与 ARDS 患者 IMV 风险增加显著相关。此外，NLR 较高与 ARDS 患者 IMV 持续时间延长相关。
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