Lin Lin, Yang Jingyue, Fu Wenning, Liu Xi, Liu Yumin, Zou Li
Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Front Med (Lausanne). 2024 Oct 2;11:1457364. doi: 10.3389/fmed.2024.1457364. eCollection 2024.
Inflammation plays a crucial role in cerebrovascular disease (CVD) progression. Neutrophil-to-lymphocyte ratio (NLR) is an important inflammatory marker, though its diagnostic role in CVD is still under investigation. This study evaluates the relationship between NLR and short-term all-cause mortality in patients with CVD admitted to the intensive care unit (ICU).
We conducted a retrospective study using data from the Medical Information Mart for Intensive Care (MIMIC-IV) (v2.2) database, including 4,327 adult ICU-admitted CVD patients. NLR values at admission were analyzed alongside various mortality variables. Multivariate Cox proportional hazards regression models and Kaplan-Meier (K-M) survival curves assessed the relationship between NLR and short-term all-cause mortality. Predictive power, sensitivity, specificity, and area under the curve (AUC) of NLR for short-term mortality were investigated using Receiver Operating Characteristic (ROC) analysis. Additionally, restricted cubic spline (RCS) curves and subgroup analyses were conducted.
Among the 4,327 patients, 3,600 survived (survival group) and 727 died (non-survival group) within 28 days of admission (mortality rate: 16.8%). A multivariate Cox regression analysis identified NLR as an independent predictor of 28-day all-cause mortality (hazard ratio: 1.013; 95% confidence interval: 1.0086-1.0188; < 0.001). The predictive model, incorporating NLR, age, gender, BMI, Charlson comorbidity index (CCI), WBC counts, Platelet, INR, and CRP, achieved an AUC of 0.686 (95% confidence interval: 0.665-0.70). While platelet-to-lymphocyte ratio was also analyzed, its predictive efficiency was less pronounced compared to NLR. A best NLR threshold of 6.19 was determined, distinguishing survivors from non-survivors. Kaplan-Meier survival curves showed that patients with NLR ≥ 6.19 had significantly lower survival rates at 7-, 14-, 21-, and 28-days. Subgroup analyses indicated that NLR did not significantly interact with most subgroups.
NLR may serve as an independent predictor for short-term all-cause mortality in ICU-admitted CVD patients, enhancing our understanding of the association between inflammatory biomarkers and CVD prognosis.
炎症在脑血管疾病（CVD）进展中起关键作用。中性粒细胞与淋巴细胞比值（NLR）是一种重要的炎症标志物，尽管其在CVD中的诊断作用仍在研究中。本研究评估了NLR与入住重症监护病房（ICU）的CVD患者短期全因死亡率之间的关系。
我们使用重症监护医学信息集市（MIMIC-IV）（v2.2）数据库的数据进行了一项回顾性研究，纳入了4327名入住ICU的成年CVD患者。分析入院时的NLR值以及各种死亡率变量。多变量Cox比例风险回归模型和Kaplan-Meier（K-M）生存曲线评估了NLR与短期全因死亡率之间的关系。使用受试者工作特征（ROC）分析研究NLR对短期死亡率的预测能力、敏感性、特异性和曲线下面积（AUC）。此外，还进行了受限立方样条（RCS）曲线和亚组分析。
在4327例患者中，3600例存活（存活组），727例在入院28天内死亡（非存活组）（死亡率：16.8%）。多变量Cox回归分析确定NLR是28天全因死亡率的独立预测因子（风险比：1.013；95%置信区间：1.0086-1.0188；P＜0.001）。纳入NLR、年龄、性别、BMI、Charlson合并症指数（CCI）、白细胞计数、血小板、国际标准化比值（INR）和C反应蛋白（CRP）的预测模型的AUC为0.686（95%置信区间：0.665-0.70）。虽然也分析了血小板与淋巴细胞比值，但其预测效率与NLR相比不太明显。确定最佳NLR阈值为6.19，可区分存活者与非存活者。Kaplan-Meier生存曲线显示，NLR≥6.19的患者在第7、14、21和28天的生存率显著较低。亚组分析表明，NLR与大多数亚组之间没有显著的相互作用。
NLR可能是入住ICU的CVD患者短期全因死亡率的独立预测因子，加深了我们对炎症生物标志物与CVD预后之间关联的理解。
