Xia Yan, Xu Heping, Xie Jinyuan, Niu Huan, Cai Xiongwei, Zhan Feng, Wu Duoyi, Yao Jinjian
Department of General Practice, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Department of Emergency Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China.
Front Med (Lausanne). 2024 Aug 15;11:1434922. doi: 10.3389/fmed.2024.1434922. eCollection 2024.
Sepsis is a life-threatening condition that requires rapid assessment to reduce mortality. This study investigates the relationship between the Neutrophil-to-Monocyte/Lymphocyte Ratio (NMLR) upon ICU admission and 28-day mortality in sepsis patients.
A retrospective analysis was performed using clinical data from sepsis patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV). Multivariate logistic regression, sensitivity analyses, and Restricted Cubic Spline (RCS) models were employed to explore the relationship between ICU admission NMLR and 28-day mortality. Kaplan-Meier method and inverse probability weighting (IPW) were used to adjust for confounders and estimate survival outcomes. Receiver operating characteristic (ROC) curve evaluating the predictive value of NLMR for 28-day mortality in ICU sepsis patients. Subgroup analyses considered factors like age, sex, race, comorbidities, and disease severity.
In total, 8,710 patients were included. Increased NMLR was associated with higher 28-day all-cause mortality, confirmed by multiple logistic regression models. In Model 3, after adjusting for confounders, each standard deviation increase in NMLR was associated with a 1.5% increase in 28-day mortality risk. Kaplan-Meier and IPW survival analyses showed higher 28-day all-cause mortality in patients with elevated NMLR levels at ICU admission compared to those with lower levels ( < 0.0001, = 0.031). RCS models suggested a potential non-linear relationship between NMLR and 28-day mortality. ROC curve for the NMLR model, with an AUC of 0.658 (95% CI: 0.642-0.673). Sensitivity analyses confirmed the association even after excluding patients with myocardial infarction and severe liver disease.
Elevated NMLR at ICU admission is significantly associated with increased 28-day all-cause mortality in sepsis patients, suggesting its potential as an early prognostic indicator for risk assessment and intervention.
脓毒症是一种危及生命的疾病，需要快速评估以降低死亡率。本研究调查了脓毒症患者入住重症监护病房（ICU）时的中性粒细胞与单核细胞/淋巴细胞比值（NMLR）与28天死亡率之间的关系。
使用重症监护医学信息集市IV（MIMIC-IV）中脓毒症患者的临床数据进行回顾性分析。采用多因素逻辑回归、敏感性分析和限制性立方样条（RCS）模型来探讨ICU入院时的NMLR与28天死亡率之间的关系。采用Kaplan-Meier法和逆概率加权（IPW）法来调整混杂因素并估计生存结局。绘制受试者工作特征（ROC）曲线，评估NLMR对ICU脓毒症患者28天死亡率的预测价值。亚组分析考虑了年龄、性别、种族、合并症和疾病严重程度等因素。
总共纳入了8710例患者。多因素逻辑回归模型证实，NMLR升高与28天全因死亡率升高相关。在模型3中，调整混杂因素后，NMLR每增加一个标准差，28天死亡风险增加1.5%。Kaplan-Meier法和IPW生存分析显示，入住ICU时NMLR水平升高的患者28天全因死亡率高于水平较低的患者（P<0.0001，P = 0.031）。RCS模型表明NMLR与28天死亡率之间可能存在非线性关系。NMLR模型的ROC曲线，曲线下面积（AUC）为0.658（95%CI：0.642-0.673）。敏感性分析证实，即使排除心肌梗死和严重肝病患者，这种关联仍然存在。
入住ICU时NMLR升高与脓毒症患者28天全因死亡率增加显著相关，表明其作为风险评估和干预的早期预后指标的潜力。
