Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China (Mr Zhang and Drs Xiancheng Chen, Cao, You, Ming Chen, Zhu, and Yu); and Department of Critical Care Medicine, Nanjing Chest Hospital, The Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China (Mr Han).
J Trauma Nurs. 2022;29(5):240-251. doi: 10.1097/JTN.0000000000000672.
Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are reported to reflect the inflammation and immune status in critically ill patients, but their role in severe trauma patients with persistent critical illness remains to be elucidated.
We aimed to evaluate the relationship of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio with persistent critical illness in severe trauma patients.
In a single-center retrospective cohort study, persistent critical illness was defined as intensive care unit length of stay of more than 10 days. Monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were computed individually and categorized into 3 tertiles. Logistic regression analysis was used to assess the relationship of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with persistent critical illness. Receiver operating characteristic curves and the Youden index were used to evaluate the discriminatory threshold of persistent critical illness.
A total of 851 eligible patients were enrolled in the study: 328 patients with persistent critical illness and 523 without. The median levels of maximum neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio during intensive care unit stay were all higher in patients with persistent critical illness than in those without (11.46 vs. 9.13, p < .001 and 0.62 vs. 0.46, p < .001). Multivariate analysis revealed that the second (≥0.385, <0.693) and third (≥0.693) maximum monocyte-to-lymphocyte ratio tertiles were significantly associated with persistent critical illness after adjusting for confounding factors (odds ratio: 1.89, 95% confidence interval: 1.10-3.26, p = .021 and odds ratio 2.69, 95% confidence interval: 1.44-5.02, p = .002, respectively), whereas maximum neutrophil-to-lymphocyte ratio was not significantly correlated with persistent critical illness. The area under the curve for the maximum monocyte-to-lymphocyte ratio was 0.63 (95% confidence interval: 0.59-0.67), and the optimal cutoff was 0.65 for persistent critical illness.
A high maximum monocyte-to-lymphocyte ratio during intensive care unit stay was independently related to persistent critical illness following severe trauma, although with limited sensitivity and specificity.
中性粒细胞与淋巴细胞比值和单核细胞与淋巴细胞比值被报道可反映危重症患者的炎症和免疫状态，但它们在持续存在危重症的重症创伤患者中的作用仍有待阐明。
本研究旨在评估中性粒细胞与淋巴细胞比值和单核细胞与淋巴细胞比值与重症创伤患者持续存在危重症的关系。
采用单中心回顾性队列研究，将持续存在危重症定义为入住重症监护病房时间超过 10 天。单独计算单核细胞与淋巴细胞比值和中性粒细胞与淋巴细胞比值，并将其分为 3 个三分位。采用 logistic 回归分析评估单核细胞与淋巴细胞比值和中性粒细胞与淋巴细胞比值与持续存在危重症的关系。采用受试者工作特征曲线和约登指数评估持续存在危重症的临界值。
共纳入 851 例符合条件的患者：328 例患者持续存在危重症，523 例患者无持续存在危重症。持续存在危重症患者的重症监护病房期间最大中性粒细胞与淋巴细胞比值和最大单核细胞与淋巴细胞比值中位数均高于无持续存在危重症患者（11.46 比 9.13，p<0.001 和 0.62 比 0.46，p<0.001）。多变量分析显示，在调整混杂因素后，第二（≥0.385，<0.693）和第三（≥0.693）最大单核细胞与淋巴细胞比值三分位与持续存在危重症显著相关（比值比：1.89，95%置信区间：1.10-3.26，p=0.021 和比值比：2.69，95%置信区间：1.44-5.02，p=0.002），而最大中性粒细胞与淋巴细胞比值与持续存在危重症无显著相关性。最大单核细胞与淋巴细胞比值的曲线下面积为 0.63（95%置信区间：0.59-0.67），最佳临界值为 0.65 用于持续存在危重症。
重症监护病房期间最大单核细胞与淋巴细胞比值升高与重症创伤后持续存在危重症独立相关，但敏感性和特异性均有限。
