肌钙蛋白、中性粒细胞与淋巴细胞比值以及单核细胞与淋巴细胞比值等血液生物标志物是急性冠状动脉综合征高危死亡率的有效预测指标。
Hematological biomarkers of troponin, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio serve as effective predictive indicators of high-risk mortality in acute coronary syndrome.
作者信息
de Liyis Bryan G, Ciaves Angela F, Intizam Marwa H, Jusuf Pierre J, Artha I Made J Rina
机构信息
Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia.
Department of Cardiology and Vascular Medicine, Universitas Udayana, Denpasar, Bali, Indonesia.
出版信息
Biomedicine (Taipei). 2023 Dec 1;13(4):32-43. doi: 10.37796/2211-8039.1425. eCollection 2023.
BACKGROUND
Assessing high-risk mortality in acute coronary syndrome (ACS) patients, encompassing ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI), and Unstable Angina Pectoris (UAP), is crucial. However, the prognostic significance of hematological parameters in predicting high-risk mortality in ACS patients remains uncertain despite advancements in ACS research.
AIM
The aim was to investigate prognostic significance of hematological parameters troponin, Creatine Kinase-MB (CKMB), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocyte-to-Lymphocyte Ratio (MLR), Basophil-to-Lymphocyte Ratio (BLR), and Eosinophil-to-Lymphocyte Ratio (ELR) levels in predicting high-risk mortality in ACS patients.
METHODS
In this retrospective observational study, data from medical records of 115 patients with ACS, including 40 with STEMI, 38 with NSTEMI, and 37 with UAP, were analyzed. Patients were selected using stratified random sampling, whereby five patients were randomly chosen each month from January 2021 to December 2022 while maintaining a 1:1:1 ratio of selection.
RESULTS
Troponin (r = 0.519) and NLR (r = 0.484) showed moderate positive correlations with high-risk STEMI mortality. Meanwhile, troponin (r = 0.387), NLR (r = 0.279), PLR (r = 0.276), MLR (r = 0.250), BLR (r = 0.237), and ELR (r = -0.344) were found to be significantly correlated with high-risk ACS mortality. Troponin, CKMB, NLR, and MLR were significant (AUC>0.7) for high-risk STEMI mortality, and Troponin, NLR, and MLR were significant for high-risk ACS mortality. The results of the multivariate regression analysis indicated that only Troponin (OR:2.049; 95%CI: 1.802-8.218; p = 0.014), NLR (OR:1.652; 95%CI: 1.306-7.753; p = 0.030), and MLR (OR:4.067; 95%CI: 1.182-13.987; p = 0.026) were capable of predicting high-risk ACS mortality. Sub-group analysis showed an increased risk of ACS mortality by GRACE score >140 in patients with elevated levels of Troponin (OR:2.787; 95%CI: 1.032-7.524; p < 0.05), NLR (OR:3.287; 95%CI: 1.340-8.059; p < 0.05), and MLR (OR:4.156; 95%CI: 1.634-10.569; p < 0.05) above the cut-off value.
CONCLUSION
Troponin, NLR, and MLR levels above the cutoff independently predict high-risk mortality in ACS.
背景
评估急性冠状动脉综合征（ACS）患者的高危死亡率至关重要，ACS包括ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）和不稳定型心绞痛（UAP）。然而，尽管ACS研究取得了进展，但血液学参数在预测ACS患者高危死亡率方面的预后意义仍不明确。
目的
旨在研究血液学参数肌钙蛋白、肌酸激酶同工酶（CKMB）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）、嗜碱性粒细胞与淋巴细胞比值（BLR）和嗜酸性粒细胞与淋巴细胞比值（ELR）水平在预测ACS患者高危死亡率中的预后意义。
方法
在这项回顾性观察研究中，分析了115例ACS患者的病历数据，其中包括40例STEMI患者、38例NSTEMI患者和37例UAP患者。采用分层随机抽样选择患者，即从2021年1月至2022年12月每月随机选择5例患者，同时保持1:1:1的选择比例。
结果
肌钙蛋白（r = 0.519）和NLR（r = 0.484）与STEMI高危死亡率呈中度正相关。同时，发现肌钙蛋白（r = 0.387）、NLR（r = 0.279）、PLR（r = 0.276）、MLR（r = 0.250）、BLR（r = 0.237）和ELR（r = -0.344）与ACS高危死亡率显著相关。肌钙蛋白、CKMB、NLR和MLR对STEMI高危死亡率具有显著意义（AUC>0.7），肌钙蛋白、NLR和MLR对ACS高危死亡率具有显著意义。多因素回归分析结果表明，只有肌钙蛋白（OR:2.049；95%CI: 1.802 - 8.218；p = 0.014）、NLR（OR:1.6,52；95%CI: 1.306 - 7.753；p = 0.030）和MLR（OR:4.067；,95%CI: 1.182 - 13.987；p = 0.026）能够预测ACS高危死亡率。亚组分析显示，肌钙蛋白、NLR和MLR水平高于临界值的患者，GRACE评分>140时ACS死亡风险增加（OR:2.787；95%CI: 1.032 - 7.524；p < 0.05）、（OR:3.2,87；95%CI: 1.340 - 8.059；p < 0.05）和（OR:4.156；95%CI: 1.634 - 10.569；p < 0.05）。
结论
高于临界值的肌钙蛋白、NLR和MLR水平可独立预测ACS患者的高危死亡率。
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