急性缺血性脑卒中患者的中性粒细胞与淋巴细胞比值及五年死亡率
Neutrophil to lymphocyte ratio and five-year mortality in patients with acute ischemic stroke.
作者信息
Shan Yisi, Zhang Rong, Lu Juan, Huang Lingling, Wang Yadong, Long Fengdan, Sun Yaming
机构信息
Department of Neurology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, Suzhou, 215600, China.
出版信息
Heliyon. 2024 Aug 23;10(17):e36827. doi: 10.1016/j.heliyon.2024.e36827. eCollection 2024 Sep 15.
BACKGROUND
Previous studies linked neutrophil to lymphocyte ratio (NLR) with short-term mortality after acute ischemic stroke (AIS), but its relationship with long-term mortality remains unclear. This study investigates the association between NLR and five-year mortality in AIS patients.
METHOD
We analyzed 416 AIS patients from April 2012 to January 2016 at Zhangjiagang TCM Hospital. Admission NLR was divided into quartiles: Q1 (<2.00), Q2 (2.00-3.05), Q3 (3.06-5.46), and Q4 (≥5.46). We assessed 5-year all-cause and vascular mortality using Kaplan-Meier, Cox regression, and receiver operating characteristic (ROC) curve analyses.
RESULTS
Over five years, 134 (32.2 %) all-cause deaths and 114 (27.4 %) vascular deaths occurred. Elevated NLR was significantly associated with increased risks of all-cause and vascular mortality. Multivariate Cox analysis identified stroke history (HR: 1.57, 95 % CI 1.08-2.30), baseline National Institutes of Health Stroke Scale (NIHSS) score (HR: 1.09, 95 % CI 1.05-1.12), and NLR (HR: 1.09, 95 % CI 1.05-1.12) as independent risk factors for all-cause mortality. These factors also predicted 5-year vascular mortality: stroke history (HR: 1.65, 95 % CI 1.10-2.49), NIHSS score (HR: 1.10, 95 % CI 1.06-1.13), and NLR (HR: 1.08, 95 % CI 1.05-1.10). NLR quartiles were significantly linked to both outcomes: all-cause mortality HRs were Q2 (1.87, 95 % CI 1.00-3.51), Q3 (2.40, 95 % CI 1.31-4.39), Q4 (2.77, 95 % CI 1.47-5.24), P for trend = 0.001; vascular mortality HRs were Q2 (1.76, 95 % CI 0.88-3.55), Q3 (2.34, 95 % CI 1.14-4.40), Q4 (2.57, 95 % CI 1.28-5.16), P for trend = 0.002. Kaplan-Meier survival analysis revealed significantly higher mortality rates in higher NLR quartiles (log-rank p < 0.001). ROC analysis identified optimal NLR cutoff values of 3.42 for predicting 5-year all-cause mortality (AUC 0.689) and 3.51 for vascular-cause mortality (AUC 0.700), with moderate sensitivity and specificity.
CONCLUSIONS
Higher NLR at admission was linked with five-year all-cause mortality and mortality attributed explicitly to vascular causes in AIS patients.
背景
既往研究将急性缺血性卒中（AIS）后中性粒细胞与淋巴细胞比值（NLR）与短期死亡率相关联，但其与长期死亡率的关系仍不明确。本研究调查了AIS患者中NLR与五年死亡率之间的关联。
方法
我们分析了2012年4月至2016年1月在张家港中医医院的416例AIS患者。入院时的NLR分为四分位数：Q1（<2.00）、Q2（2.00 - 3.05）、Q3（3.06 - 5.46）和Q4（≥5.46）。我们使用Kaplan-Meier法、Cox回归和受试者工作特征（ROC）曲线分析评估了5年全因死亡率和血管性死亡率。
结果
在五年期间，发生了134例（32.2%）全因死亡和114例（27.4%）血管性死亡。NLR升高与全因死亡率和血管性死亡率增加显著相关。多变量Cox分析确定卒中病史（HR：1.57，95%CI 1.08 - 2.30）、基线美国国立卫生研究院卒中量表（NIHSS）评分（HR：1.09，95%CI 1.05 - 1.12）和NLR（HR：1.09，95%CI 1.05 - {此处原文有误，应为1.13}）为全因死亡率的独立危险因素。这些因素也可预测5年血管性死亡率：卒中病史（HR：1.65，95%CI 1.10 - 2.49）、NIHSS评分（HR：1.10，95%CI 1.06 - 1.13）和NLR（HR：1.08，95%CI 1.05 - 1.10）。NLR四分位数与这两种结局均显著相关：全因死亡率HRs为Q2（1.87，95%CI 1.00 - 3.51）、Q3（2.40，95%CI 1.31 - 4.39）、Q4（2.77，95%CI 1.47 - 5.24），趋势P = 0.001；血管性死亡率HRs为Q2（1.76，95%CI 0.88 - 3.55）、Q3（2.34，95%CI 1.14 - 4.40）、Q4（2.57，95%CI 1.28 - 5.16），趋势P = 0.002。Kaplan-Meier生存分析显示，较高NLR四分位数的死亡率显著更高（对数秩检验p < 0.001）。ROC分析确定预测5年全因死亡率的最佳NLR临界值为3.（此处原文有误，应为42）（AUC 0.689），预测血管性死亡率的最佳NLR临界值为3.51（AUC 0.700），敏感性和特异性中等。
结论
入院时较高的NLR与AIS患者的五年全因死亡率以及明确归因于血管原因的死亡率相关。
Zotero 插件