中性粒细胞与淋巴细胞比值对 TAVR 术后死亡率和围手术期肺动脉高压的影响。
Effect of Neutrophil-to-Lymphocyte Ratio on Post-TAVR Mortality and Periprocedural Pulmonary Hypertension.
机构信息
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
出版信息
J Interv Cardiol. 2024 Feb 20;2024:4512655. doi: 10.1155/2024/4512655. eCollection 2024.
AIMS
To evaluate the impact of neutrophil-to-lymphocyte ratio (NLR) on periprocedural pulmonary hypertension (PH) and 3-month all-cause mortality in patients with aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) and to develop a nomogram for predicting the mortality for these patients.
METHODS AND RESULTS
124 patients undergoing TAVR were categorized into three groups according to systolic pulmonary artery pressure (sPAP): Group I (no PH, = 61) consisted of patients with no pre- and post-TAVR PH; Group II (improved PH, = 35) consisted of patients with post-TAVR systolic pulmonary artery pressure (sPAP) decreased by more than 10 mmHg compared to pre-TAVR levels; and Group III (persistent PH, = 28) consisted of patients with post-TAVR sPAP no decrease or less than 10 mmHg, or new-onset PH after the TAVR procedure. The risk of all-cause mortality within 3 months tended to be higher in Group II (11.4%) and Group III (14.3%) compared to Group I (3.3%) (=0.057). The multinomial logistic regression analysis demonstrated a positive correlation between NLR and both improved PH (OR: 1.182, 95% CI: 1.036-1.350, =0.013) and persistent PH (OR: 1.181, 95% CI: 1.032-1.352, =0.016). Kaplan-Meier analysis revealed a significant association between higher NLR and increased 3-month all-cause mortality (16.1% vs. 3.1% in lower NLR group, =0.021). The multivariable Cox regression analysis confirmed that NLR was an independent predictor for all-cause mortality within 3 months, even after adjusting for clinical confounders. A nomogram incorporating five factors (BNP, heart rate, serum total bilirubin, NLR, and comorbidity with coronary heart disease) was developed. ROC analysis was performed to discriminate the ability of the nomogram, and the AUC was 0.926 (95% CI: 0.850-1.000, < 0.001).
CONCLUSIONS
Patients with higher baseline NLR were found to be at an increased risk of periprocedural PH and all-cause mortality within 3 months after TAVR.
目的
评估中性粒细胞与淋巴细胞比值（NLR）对接受经导管主动脉瓣置换术（TAVR）的主动脉瓣狭窄（AS）患者围手术期肺动脉高压（PH）和 3 个月全因死亡率的影响，并为这些患者的死亡率预测建立一个列线图。
方法和结果
根据收缩期肺动脉压（sPAP）将 124 例接受 TAVR 的患者分为三组：I 组（无 PH，n=61）包括术前和术后无 PH 的患者；II 组（改善 PH，n=35）包括与术前相比 sPAP 降低超过 10mmHg 的患者；III 组（持续 PH，n=28）包括术后 sPAP 无下降或下降小于 10mmHg 或 TAVR 术后新发 PH 的患者。与 I 组（3.3%）相比，II 组（11.4%）和 III 组（14.3%）的 3 个月内全因死亡率风险更高（=0.057）。多变量逻辑回归分析显示，NLR 与改善 PH（OR：1.182，95%CI：1.036-1.350，=0.013）和持续 PH（OR：1.181，95%CI：1.032-1.352，=0.016）均呈正相关。Kaplan-Meier 分析显示，较高的 NLR 与 3 个月全因死亡率增加之间存在显著关联（NLR 较高组为 16.1%，NLR 较低组为 3.1%，=0.021）。多变量 Cox 回归分析证实，NLR 是 3 个月内全因死亡率的独立预测因素，即使在调整了临床混杂因素后也是如此。建立了一个包含五个因素（BNP、心率、血清总胆红素、NLR 和冠心病合并症）的列线图。进行了 ROC 分析以区分列线图的能力，AUC 为 0.926（95%CI：0.850-1.000，<0.001）。
结论
基线 NLR 较高的患者在接受 TAVR 后 3 个月内发生围手术期 PH 和全因死亡率的风险增加。
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