Xin Jiayan, Liu Yingwu, Zhang Chong, Wang Qi
Department of cardiology, The Third Central Hospital of Tianjin, Tianjin, China.
Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.
BMJ Open. 2025 Apr 3;15(4):e096621. doi: 10.1136/bmjopen-2024-096621.
To assess the prognostic efficacy of innovative inflammatory indicators, specifically the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), in conjunction with the Global Registry of Acute Coronary Events (GRACE) score, for predicting adverse in-hospital outcomes among patients diagnosed with ST-segment elevation myocardial infarction (STEMI).
This study is a single-centre retrospective analysis of patients with STEMI treated at the Cardiology Department of Tianjin Third Central Hospital between 1 January 2018 and 31 December 2023. All data were sourced from the hospital's medical record system.
The integration of the GRACE score with NLR and PLR facilitated the creation of an innovative predictive model. The model's predictive efficacy for in-hospital major adverse cardiovascular event (MACE) occurrence was assessed through receiver operating characteristic (ROC) curve analysis and multivariate logistic regression. Additionally, the Net Reclassification Improvement and Integrated Discrimination Improvement were computed to quantify enhancements in predictive value.
Patients were stratified into the MACE (N=167) and the non-MACE group (N=1011) based on the incidence of MACE. A comparison of baseline characteristics between the two groups revealed 13 potential confounding variables. The NLR and PLR levels were converted into binary variables using ROC curve analysis. Univariate logistic regression indicated that both NLR and PLR were significant risk factors for MACE during hospitalisation. After adjusting for confounders, multivariate logistic regression confirmed NLR as an independent predictor of MACE risk in this cohort. Furthermore, both NLR and PLR augmented the predictive accuracy of the GRACE score, with their combined use offering a significant improvement in its predictive capacity.
The NLR possesses the capability to independently forecast the risk of MACE during the hospitalisation period for patients diagnosed with STEMI. The incorporation of the PLR and NLR with the GRACE score serves to augment its predictive precision.
评估创新炎症指标，特别是中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR），结合全球急性冠状动脉事件注册研究（GRACE）评分，对诊断为ST段抬高型心肌梗死（STEMI）患者住院不良结局的预测效能。
本研究是对2018年1月1日至2023年12月31日在天津市第三中心医院心内科接受治疗的STEMI患者进行的单中心回顾性分析。所有数据均来自医院病历系统。
将GRACE评分与NLR和PLR相结合，构建了一个创新预测模型。通过受试者工作特征（ROC）曲线分析和多因素逻辑回归评估该模型对住院期间主要不良心血管事件（MACE）发生的预测效能。此外，计算净重新分类改善和综合判别改善，以量化预测价值的提高。
根据MACE发生率将患者分为MACE组（N = 167）和非MACE组（N = 1011）。两组基线特征比较显示有13个潜在混杂变量。利用ROC曲线分析将NLR和PLR水平转换为二元变量。单因素逻辑回归表明，NLR和PLR均为住院期间MACE的显著危险因素。校正混杂因素后，多因素逻辑回归证实NLR是该队列中MACE风险的独立预测因素。此外，NLR和PLR均提高了GRACE评分的预测准确性，两者联合使用显著提高了其预测能力。
NLR能够独立预测诊断为STEMI患者住院期间MACE的风险。将PLR和NLR纳入GRACE评分可提高其预测精度。
