中性粒细胞与淋巴细胞比值对预测慢性阻塞性肺疾病急性加重住院患者 90 天不良预后的预测价值。

Prognostic Value of Neutrophil to Lymphocyte Ratio for Predicting 90-Day Poor Outcomes in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

机构信息

Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, People's Republic of China.

Department of Respiratory and Critical Care Medicine, Fushun People's Hospital, Zigong, Sichuan, 643200, People's Republic of China.

出版信息

Int J Chron Obstruct Pulmon Dis. 2023 Jun 14;18:1219-1230. doi: 10.2147/COPD.S399671. eCollection 2023.

DOI:10.2147/COPD.S399671

PMID:37337582

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10276987/

Abstract

OBJECTIVE

This study aimed to evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) for poor outcomes within 90-day in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS

A retrospective study including 503 AECOPD patients was performed, and the subjects' clinical characteristics were collected. Binary logistic regression analysis was used to identify risk factors for 90-day poor outcomes in patients with AECOPD. Receiver-operating characteristic curves (ROC) and areas under the curves (AUC) were used to assess the ability of different biomarkers to predict the risk of 90-day mortality, readmission and re-exacerbation in patients with AECOPD.

RESULTS

During the follow-up, 188 patients (38.4%) redeveloped exacerbations, 112 patients (22.9%) were readmitted, and 20 patients (4.1%) died directly resulted from COPD or COPD-related causes. Multivariate analysis demonstrated that age>72 years (OR: 14.817, 95% CI: 1.561-140.647), NLR>14.17 (OR: 9.611, 95% CI: 2.303-40.113), EOS<0.15% (OR: 8.621, 95% CI: 3.465-34.913) and BNP>2840ng/L (OR: 5.291, 95% CI: 1.367-20.474) at discharge were independent risk factors for 90-day mortality in AECOPD patients. NLR was the optimal biomarker for predicting 90-day mortality with an AUC of 0.802 (95% CI: 0.631-0.973). Using 14.17 as the critical value of NLR, the sensitivity was 76.7%, and the specificity was 88.9%. Compared with mortality, NLR had no significant advantage in predicting risk of short-term re-exacerbation (AUC=0.580, 95% CI:0.529-0.632, p=0.001) and readmission (AUC=0.555, 95% CI:0.497-0.614, p=0.045), with AUCs less than 0.6. In contrast, the predictive value of EOS (AUC=0.561, 95% CI:0.502-0.621, p=0.038) was slightly better than NLR in terms of readmission within 90 days. CRP did not serve as a well predictive biomarker for the risk of readmission and re-deterioration (p>0.05).

CONCLUSION

NLR is of great value in predicting the risk of poor outcomes, especially COPD associated mortality, in hospitalized patients with AECOPD within 90 days after discharge.

摘要

目的

本研究旨在评估中性粒细胞与淋巴细胞比值（NLR）对慢性阻塞性肺疾病急性加重（AECOPD）住院患者 90 天内不良结局的预测价值。

方法

对 503 例 AECOPD 患者进行回顾性研究，收集患者的临床特征。采用二元逻辑回归分析确定 AECOPD 患者 90 天不良结局的危险因素。受试者工作特征曲线（ROC）和曲线下面积（AUC）用于评估不同生物标志物预测 AECOPD 患者 90 天死亡率、再入院和再恶化风险的能力。

结果

在随访期间，188 例（38.4%）患者再次恶化，112 例（22.9%）患者再次入院，20 例（4.1%）患者直接因 COPD 或 COPD 相关原因死亡。多因素分析表明，年龄>72 岁（OR：14.817，95%CI：1.561-140.647）、NLR>14.17（OR：9.611，95%CI：2.303-40.113）、EOS<0.15%（OR：8.621，95%CI：3.465-34.913）和 BNP>2840ng/L（OR：5.291，95%CI：1.367-20.474）是 AECOPD 患者 90 天内死亡的独立危险因素。NLR 是预测 AECOPD 患者 90 天死亡率的最佳生物标志物，AUC 为 0.802（95%CI：0.631-0.973）。使用 14.17 作为 NLR 的临界值，灵敏度为 76.7%，特异性为 88.9%。与死亡率相比，NLR 在预测短期再恶化风险（AUC=0.580，95%CI：0.529-0.632，p=0.001）和再入院风险（AUC=0.555，95%CI：0.497-0.614，p=0.045）方面没有显著优势，AUC 均小于 0.6。相比之下，EOS（AUC=0.561，95%CI：0.502-0.621，p=0.038）在预测 90 天内再入院方面的预测价值略优于 NLR。CRP 不能作为预测再入院和恶化风险的良好生物标志物（p>0.05）。