血液炎症生物标志物与 AECOPD 患者临床结局的相关性：北京一项 8 年回顾性研究。
Association of Blood Inflammatory Biomarkers with Clinical Outcomes in Patients with AECOPD: An 8-Year Retrospective Study in Beijing.
机构信息
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2023 Aug 17;18:1783-1802. doi: 10.2147/COPD.S416869. eCollection 2023.
PURPOSE
To discover potential inflammatory biomarkers, which can compare favorably with traditional biomarkers, and their best cut-offs at first admission to predict clinical outcomes (short-term and long-term) and the risk of readmission among acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients.
PATIENTS AND METHODS
Novel inflammatory biomarkers (such as the neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], etc.) were compared with traditional biomarkers by Pearson's correlation test. Logistic regression analysis and receiver operating characteristic (ROC) curves were applied to judge the accuracy of these novel biomarkers to predict in-hospital mortality.
RESULTS
Surviving AECOPD patients had lower NLR, PLR, and lymphocyte-to-monocyte ratios than non-survival patients (all P < 0.001). According to Pearson's correlation test, there was a linear correlation between novel and traditional biomarkers (all P < 0.05). In terms of a single biomarker, the AUC value of NLR was the largest, which was not inferior to C-reactive protein (Z-P = 0.064), and superior to erythrocyte sedimentation rate (Z-P = 0.002) and other novel single inflammatory biomarkers (all Z-P < 0.05). The mortality of patients with NLR ≥ 4.43 was 2.308-fold higher than that of patients with NLR < 4.43. After dividing patients into a higher or lower NLR group, pooled results showed that patients with NLR ≥ 4.43 had a higher rate of treatment failure, intensive care unit admission, longer hospital length of stay, one-year mortality after the index hospitalization, and overall mortality than patients with NLR < 4.43 (all P < 0.001). Patients with NLR ≥ 4.43 were associated with higher and earlier first readmission due to AECOPD than patients with lower NLR.
CONCLUSION
NLR was the best to forecast the clinical prognosis and readmission risk among AECOPD patients, which was not inferior to CRP, and the best cut-off value of NLR was 4.43.
目的
发现潜在的炎症生物标志物，这些标志物可以优于传统生物标志物，并在慢性阻塞性肺疾病急性加重（AECOPD）患者首次入院时预测最佳截断值，以预测临床结局（短期和长期）和再入院风险。
患者和方法
通过 Pearson 相关性检验比较了新型炎症生物标志物（如中性粒细胞-淋巴细胞比[NLR]、血小板-淋巴细胞比[PLR]等）与传统生物标志物。应用逻辑回归分析和受试者工作特征（ROC）曲线判断这些新型生物标志物预测住院死亡率的准确性。
结果
存活的 AECOPD 患者的 NLR、PLR 和淋巴细胞与单核细胞比值均低于非存活患者（均 P < 0.001）。根据 Pearson 相关性检验，新型和传统生物标志物之间存在线性相关（均 P < 0.05）。就单一生物标志物而言，NLR 的 AUC 值最大，与 C 反应蛋白（Z-P = 0.064）无差异，优于红细胞沉降率（Z-P = 0.002）和其他新型单一炎症生物标志物（均 Z-P < 0.05）。NLR≥4.43 的患者死亡率是 NLR<4.43 的患者的 2.308 倍。将患者分为 NLR 较高或较低组后，汇总结果显示，NLR≥4.43 的患者治疗失败、入住重症监护病房、住院时间延长、出院后 1 年死亡率和总死亡率均高于 NLR<4.43 的患者（均 P < 0.001）。NLR≥4.43 的患者比 NLR 较低的患者首次因 AECOPD 再次入院的风险更高，时间更早。
结论
NLR 是预测 AECOPD 患者临床预后和再入院风险的最佳指标，与 CRP 相当，NLR 的最佳截断值为 4.43。
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