Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China.
BMC Infect Dis. 2023 Oct 18;23(1):697. doi: 10.1186/s12879-023-08680-4.
Sepsis is an important public health issue, and it is urgent to develop valuable indicators to predict the prognosis of sepsis. Our study aims to assess the predictive value of ICU admission (Neutrophil + Monocyte)/lymphocyte ratio (NMLR) on the 30-day mortality of sepsis patients.
A retrospective analysis was conducted in septic patients, and the data were collected from Medical Information Mart for Intensive Care IV (MIMIC-IV). Univariate and multivariate Cox regression analyses were conducted to investigate the relation between ICU admission NMLR and 30-day mortality. Restricted cubic spline (RCS) was performed to determine the optimum cut-off value of ICU admission NMLR. Survival outcomes of the two groups with different ICU admission NMLR levels were estimated using the Kaplan-Meier method and compared by the log-rank test.
Finally, 7292 patients were recruited in the study, of which 1601 died within 30 days of discharge. The non-survival group had higher ICU admission NMLR values than patients in the survival group (12.24 [6.44-23.67] vs. 8.71 [4.81-16.26], P < 0.001). Univariate and multivariate Cox regression analysis demonstrated that ICU admission NMLR was an independent prognostic predictor on 30-day mortality (Univariate: P < 0.001; multivariate: P = 0.011). The RCS model demonstrated the upturn and non-linear relationship between ICU admission NMLR and 30-day mortality (Nonlinearity: P = 0.0124). According to the KM curve analysis,30-day survival was worse in the higher ICU admission NMLR group than that in the lower ICU admission NMLR group (Log rank test, P < 0.0001).
The elevated ICU admission NMLR level is an independent risk factor for high 30-day mortality in patients with sepsis.
脓毒症是一个重要的公共卫生问题，迫切需要开发有价值的指标来预测脓毒症的预后。我们的研究旨在评估 ICU 入院时中性粒细胞+单核细胞/淋巴细胞比值（NMLR）对脓毒症患者 30 天死亡率的预测价值。
对脓毒症患者进行回顾性分析，数据来自医疗信息重症监护 IV 版（MIMIC-IV）。采用单因素和多因素 Cox 回归分析探讨 ICU 入院时 NMLR 与 30 天死亡率的关系。采用限制性立方样条（RCS）确定 ICU 入院时 NMLR 的最佳截断值。采用 Kaplan-Meier 法估计两组不同 ICU 入院时 NMLR 水平的生存结局，并采用对数秩检验进行比较。
最终纳入研究的患者 7292 例，出院后 30 天内死亡 1601 例。非生存组 ICU 入院时 NMLR 值高于生存组（12.24[6.44-23.67]比 8.71[4.81-16.26]，P<0.001）。单因素和多因素 Cox 回归分析表明，ICU 入院时 NMLR 是 30 天死亡率的独立预后预测因素（单因素：P<0.001；多因素：P=0.011）。RCS 模型显示 ICU 入院时 NMLR 与 30 天死亡率之间呈上升和非线性关系（非线性：P=0.0124）。根据 KM 曲线分析，较高 ICU 入院 NMLR 组 30 天生存率较较低 ICU 入院 NMLR 组差（对数秩检验，P<0.0001）。
升高的 ICU 入院 NMLR 水平是脓毒症患者 30 天高死亡率的独立危险因素。
