血小板与淋巴细胞比值及中性粒细胞与淋巴细胞比值作为难治性过敏反应的预测指标
Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio as predictors of refractory anaphylaxis.
作者信息
Nghi Le Vinh, Phuc Nguyen Hoang, Hai Pham Dang
机构信息
College of Health Sciences, VinUniversity, Ha Noi, Viet Nam.
Medical Intensive Care Unit, 108 Military Central Hospital, Viet Nam.
出版信息
World Allergy Organ J. 2024 Aug 8;17(8):100944. doi: 10.1016/j.waojou.2024.100944. eCollection 2024 Aug.
BACKGROUND
Refractory anaphylaxis poses an ongoing, lethal hypersensitivity response that unpredictably involves multiple organs despite appropriate intramuscular (IM) adrenaline injections. Studies on the association of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) concerning anaphylactic severity have yet to be carried out. The study aimed to evaluate the association between blood PLR and NLR levels and refractory anaphylaxis.
METHODS
We carried out a retrospective cross-sectional study in which medical records of patients with anaphylaxis who sought urgent care at the Emergency Department (ED) of Tertiary Hospital in Hanoi, Vietnam, were evaluated. Based on the United Kingdom Resuscitation Council guidelines in 2021, patients were classified as refractory anaphylaxis if they needed more than two appropriate doses of intramuscular adrenaline for anaphylactic symptoms resolution. Clinical data and laboratory results were obtained in the medical records. Logistic regression analysis determined the association between contributing factors and refractory anaphylaxis.
RESULTS
One-hundred eighteen adults (age 51.80 ± 18.25 years) were analyzed, including 38 refractory anaphylaxis patients (32.2%). Refractory anaphylaxis patients exhibited notably elevated platelet-to-lymphocyte ratio (PLR) ( = 0.006) and increased neutrophil-to-lymphocyte ratio (NLR) ( < 0.001) in comparison to non-refractory anaphylaxis patients. Receiver operating characteristic curve (ROC) analysis demonstrated an optimal PLR cutoff value of 129.5 (area under the ROC curve [AUC] 0.658, sensitivity 73.68%, specificity 61.25%, = 0.004) and an optimal NLR cutoff value of 4 (AUC 0.736, sensitivity 65.79%, specificity 73.75%, < 0.001) for refractory anaphylaxis. Multivariate logistic regression analysis revealed a PLR≥129.5 (OR = 4.83, 95% CI: 1.87-12.48) and an NLR≥4 (OR = 4.60, 95% CI: 1.86-11.41) were independently associated with refractory anaphylaxis.
CONCLUSION
Elevated PLR and NLR serve as independent indicators significantly associated with refractory anaphylaxis.
背景
难治性过敏反应是一种持续存在的致命性超敏反应，尽管已进行了适当的肌肉注射肾上腺素治疗，但仍不可预测地累及多个器官。关于血小板与淋巴细胞比值（PLR）和中性粒细胞与淋巴细胞比值（NLR）与过敏严重程度之间关联的研究尚未开展。本研究旨在评估血液中PLR和NLR水平与难治性过敏反应之间的关联。
方法
我们进行了一项回顾性横断面研究，对在越南河内一家三级医院急诊科寻求紧急治疗的过敏反应患者的病历进行了评估。根据英国复苏委员会2021年的指南，如果患者需要超过两剂适当剂量的肌肉注射肾上腺素才能缓解过敏症状，则将其分类为难治性过敏反应。从病历中获取临床数据和实验室结果。逻辑回归分析确定了影响因素与难治性过敏反应之间的关联。
结果
共分析了118名成年人（年龄51.80±18.25岁），其中38名为难治性过敏反应患者（32.2%）。与非难治性过敏反应患者相比，难治性过敏反应患者的血小板与淋巴细胞比值（PLR）显著升高（P = 0.006），中性粒细胞与淋巴细胞比值（NLR）增加（P < 0.001）。受试者工作特征曲线（ROC）分析显示，难治性过敏反应的最佳PLR临界值为129.5（ROC曲线下面积[AUC]为0.658，灵敏度为73.68%，特异性为61.25%，P = 0.004），最佳NLR临界值为4（AUC为0.736，灵敏度为65.79%，特异性为73.75%，P < 0.001）。多因素逻辑回归分析显示，PLR≥129.5（OR = 4.83，95%可信区间：1.87 - 12.48）和NLR≥4（OR = 4.60，95%可信区间：1.86 - 11.41）与难治性过敏反应独立相关。
结论
PLR和NLR升高是与难治性过敏反应显著相关的独立指标。
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