Ibrahim Ethar N, Alrashdan Hisham A, Alshiyyab Osama, Ikhwayleh Zuhier A, Alboun Samer, Al-Theiabat Abedal-Rahman I, Al-Shatnawi Ali F, Aldeeb Mohammad T, Almiqdad Yarub M, Cycline Mino
Anaesthesia Department, Royal Medical Services, Irbid, JOR.
Otolaryngology - Head and Neck Surgery Department, Jordanian Royal Medical Services, Amman, JOR.
Cureus. 2024 Jul 9;16(7):e64197. doi: 10.7759/cureus.64197. eCollection 2024 Jul.
The neutrophil-to-lymphocyte ratio (NLR) is commonly used as a prognostic indicator for microbiological and inflammatory conditions in clinical settings. However, the quotient to albumin levels, which is another nutritional and clinical predictor, may also have an interesting diagnostic and prognostic value. This study aimed to primarily investigate the predictive performances of the neutrophils to albumin and lymphocytes ratio (NALR) compared to the NLR in predicting poor outcomes during hospital admission, particularly the decomposition of respiratory, renal, liver, and circulatory systems, resulting in longer hospital stays or mortality.
An observational study was performed on a cohort of 270 hospitalised patients admitted to Rashid bin Al-Hussein Military Hospital during the period from October 2023 to early November 2023. The study specifically targeted adult patients (age >17 years) who had a minimum of 80% availability of their initial and follow-up data during admission. We dichotomised all eligible test patients into two groups: Group I, which represented better outcomes of interest, and Group II, which represented poorer outcomes of interest. Statistically, we conducted binary logistic, receiver operating, and sensitivity analyses to explore the predictive performances and indices for NALR and NLR. We also conducted chi-square and independent T analyses to uncover the distribution rates of the independent variables across Groups I and II. We considered a p-value of less than 0.05 as the level of significance.
Out of a total sample size of 270, 82 patients (30.37%) were allocated to Group I, and 188 patients (69.63%) were allocated to Group II. Males outnumbered females in this study by 184 (68.1%) to 86 (31.9%). Patients in the study had an average age of 58.08±10.02 years. The average hospitalisation took 13.71±6.38 days, significantly longer in Group II compared to Group I (15.43±6.76 days vs. 9.77±2.69 days, p-value<0.05). We found that the area under the receiver operating characteristic (ROC) curves was estimated at [0.808±0.031 (0.748-0.868), p-value=0.000] and [0.667±0.034 (0.601-0.733), p-value=0.000] for NALR and NLR, respectively. The optimal operating thresholds for NALR and NLR were 1.5 and 5.37, with sensitivities and specificities of 86.7% versus 73.4% and 70.73% versus 70.73%, respectively.
The proposed NALR showed superior predictive performance, sensitivity, and correlation compared to the parent NLR. Both tools can be used in clinical practice to prioritise clinical and pharmacotherapeutics for hospitalised patients based on unfavourable outcomes.
中性粒细胞与淋巴细胞比值（NLR）在临床环境中通常用作微生物学和炎症性疾病的预后指标。然而，与白蛋白水平的比值，这是另一种营养和临床预测指标，可能也具有有趣的诊断和预后价值。本研究旨在主要调查中性粒细胞与白蛋白及淋巴细胞比值（NALR）与NLR相比，在预测住院期间不良结局方面的预测性能，特别是呼吸、肾脏、肝脏和循环系统的功能衰退，导致住院时间延长或死亡。
对2023年10月至2023年11月初入住拉希德·本·侯赛因军事医院的270名住院患者进行了一项观察性研究。该研究专门针对成年患者（年龄>17岁），这些患者在入院期间初始和随访数据的可用性至少为80%。我们将所有符合条件的测试患者分为两组：第一组代表感兴趣的较好结局，第二组代表感兴趣的较差结局。在统计学上，我们进行了二元逻辑回归、受试者工作特征分析和敏感性分析，以探索NALR和NLR的预测性能和指标。我们还进行了卡方分析和独立T分析，以揭示自变量在第一组和第二组中的分布率。我们将p值小于0.05视为显著性水平。
在270名总样本量中，82名患者（30.37%）被分配到第一组，188名患者（69.63%）被分配到第二组。本研究中男性多于女性，分别为184名（68.1%）和86名（31.9%）。研究中的患者平均年龄为58.08±10.02岁。平均住院时间为13.71±6.38天，第二组明显长于第一组（15.43±6.76天对9.77±2.69天，p值<0.05）。我们发现，受试者工作特征（ROC）曲线下面积分别估计为NALR的[0.808±0.031（0.748 - 0.868），p值 = 0.000]和NLR的[0.667±0.034（0.601 - 0.733），p值 = 0.000]。NALR和NLR的最佳操作阈值分别为1.5和5.37，敏感性和特异性分别为86.7%对73.4%和70.73%对70.73%。
与母体NLR相比，所提出的NALR显示出卓越的预测性能、敏感性和相关性。这两种工具均可用于临床实践，根据不良结局为住院患者确定临床和药物治疗的优先级。
