Zhu Yingchao, Bi Yaodan, Liu Bin, Zhu Tao
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Anesthesiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Front Med (Lausanne). 2023 Mar 8;10:1102733. doi: 10.3389/fmed.2023.1102733. eCollection 2023.
The preoperative elevated neutrophil-to-lymphocyte ratio (NLR) was reported to be associated with poorer outcomes after cancer and cardiovascular surgeries. It is unclear, however, if the predictive value is particular or if it may be applied to other types of surgery. We aimed to assess the prognostic value of preoperative NLR levels for morbidity and mortality after various surgery and determine an optimal threshold for NLR.
We conducted a cohort analysis on patients receiving surgery at Sichuan University West China Hospital between 2018 and 2020. Multivariable piecewise regression analysis were used to determine the optimal cutoff value of NLR. Subgroup analysis were performed to verify the correlation. Sensitivity analysis was used to explore the effect of different thresholds.
We obtained data from 136,347 patients. The optimal cutoff of NLR was determined as 3.6 [95% CI (3.0, 4.1)] by piecewise regression method. After multivariable adjustment, preoperative high NLR remained significantly associated with increased in-hospital mortality (aOR, 2.19; 95% CI, 1.90-2.52; < 0.001) and ICU admission after surgery (aOR, 1.69; 95% CI, 1.59-1.79; < 0.001). Subgroup analyses confirmed the predictive value of high NLR in multiple surgical subgroups, including general, orthopedic, neurosurgical, and thoracic surgery subgroups, otorhinolaryngology, head and neck surgery, and burn plastic surgery. A NLR threshold of 3.6 gave excellent predictive value, whether employed alone or added in an extended model.
In conclusion, the association of elevated NLR with higher mortality and ICU admission can be extended to a wider range of procedures. NLR threshold of 3.6 could provide good prognostic value for the prognostic model.
术前中性粒细胞与淋巴细胞比值（NLR）升高与癌症和心血管手术后较差的预后相关。然而，其预测价值是否具有特殊性，或者是否可应用于其他类型的手术尚不清楚。我们旨在评估术前NLR水平对各种手术后发病率和死亡率的预后价值，并确定NLR的最佳阈值。
我们对2018年至2020年期间在四川大学华西医院接受手术的患者进行了队列分析。采用多变量分段回归分析来确定NLR的最佳截断值。进行亚组分析以验证相关性。采用敏感性分析来探讨不同阈值的影响。
我们获得了136347例患者的数据。通过分段回归法确定NLR的最佳截断值为3.6[95%CI（3.0，4.1）]。经过多变量调整后，术前高NLR仍与住院死亡率增加（调整后比值比，2.19；95%CI，1.90 - 2.52；P < 0.001）和术后入住重症监护病房（ICU）（调整后比值比，1.69；95%CI，1.59 - 1.79；P < 0.001）显著相关。亚组分析证实了高NLR在多个手术亚组中的预测价值，包括普通外科、骨科、神经外科和胸外科亚组、耳鼻咽喉头颈外科以及烧伤整形科。NLR阈值为3.6时，无论单独使用还是添加到扩展模型中，都具有出色的预测价值。
总之，NLR升高与更高死亡率和ICU入住率之间的关联可扩展到更广泛的手术类型。NLR阈值为3.6可为预后模型提供良好的预后价值。
