Shi Xiaopeng, Yang Lei, Bai Weimin, Jing Lijuan, Qin Lijie
Department of Emergency, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China.
Front Med (Lausanne). 2024 Jan 31;11:1342568. doi: 10.3389/fmed.2024.1342568. eCollection 2024.
This study aims to explore the value of the Lymphocyte-to-Monocyte Ratio (LMR) in predicting delirium among older adult patients with sepsis.
Retrospective data were obtained from the MIMIC-IV database in accordance with the STROBE guidelines. Patients aged 65 and above, meeting the Sepsis 3.0 criteria, were selected for this study. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Demographic information, comorbid conditions, severity of illness scores, vital sign measurements, and laboratory test results were meticulously extracted. The prognostic utility of the Lymphocyte-to-Monocyte Ratio (LMR) in predicting delirium was assessed through logistic regression models, which were carefully adjusted for potential confounding factors.
In the studied cohort of 32,971 sepsis patients, 2,327 were identified as meeting the inclusion criteria. The incidence of delirium within this subgroup was observed to be 55%. A univariate analysis revealed a statistically significant inverse correlation between the Lymphocyte-to-Monocyte Ratio (LMR) and the risk of delirium ( < 0.001). Subsequent multivariate analysis, which accounted for comorbidities and illness severity scores, substantiated the role of LMR as a significant predictive marker. An optimized model, achieving the lowest Akaike Information Criterion (AIC), incorporated 17 variables and continued to demonstrate LMR as a significant prognostic factor ( < 0.01). Analysis of the Receiver Operating Characteristic (ROC) curve indicated a significant enhancement in the Area Under the Curve (AUC) upon the inclusion of LMR ( = 0.035).
The Lymphocyte-to-Monocyte Ratio (LMR) serves as a significant, independent prognostic indicator for the occurrence of delirium in older adult patients with sepsis. Integrating LMR into existing predictive models markedly improves the identification of patients at elevated risk, thereby informing and potentially guiding early intervention strategies.
本研究旨在探讨淋巴细胞与单核细胞比值（LMR）在预测老年脓毒症患者谵妄中的价值。
根据STROBE指南从MIMIC-IV数据库中获取回顾性数据。选择年龄在65岁及以上、符合脓毒症3.0标准的患者进行本研究。使用重症监护病房谵妄评估方法（CAM-ICU）评估谵妄。精心提取人口统计学信息、合并症、疾病严重程度评分、生命体征测量值和实验室检查结果。通过逻辑回归模型评估淋巴细胞与单核细胞比值（LMR）在预测谵妄中的预后效用，并针对潜在混杂因素进行了仔细调整。
在32971例脓毒症患者的研究队列中，有2327例被确定符合纳入标准。该亚组中谵妄的发生率为55%。单因素分析显示淋巴细胞与单核细胞比值（LMR）与谵妄风险之间存在统计学显著的负相关（<0.001）。随后的多因素分析考虑了合并症和疾病严重程度评分，证实了LMR作为重要预测标志物的作用。一个达到最低赤池信息准则（AIC）的优化模型纳入了17个变量，并继续证明LMR是一个重要的预后因素（<0.01）。对受试者工作特征（ROC）曲线的分析表明，纳入LMR后曲线下面积（AUC）有显著提高（=0.035）。
淋巴细胞与单核细胞比值（LMR）是老年脓毒症患者发生谵妄的重要独立预后指标。将LMR纳入现有的预测模型可显著改善对高危患者的识别，从而为早期干预策略提供信息并可能进行指导。
