Li Yunxia, Lang Yujie, Deng Ke, Zhou Dongmei, Kang Lili, Li Xiaoying
Department of Neonatology, Jinan Children's Hospital, Jinan, Shandong, China.
Department of Neonatology, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Front Pediatr. 2025 Jun 17;13:1555981. doi: 10.3389/fped.2025.1555981. eCollection 2025.
Perinatal hypoxic-ischemic Encephalopathy (HIE) is a disease of high mortality and morbidity. The neutrophil ratio (NR), a key indicator, is widely used in clinical practice. However, the relationship between dynamically changing NR and the short-term prognosis of HIE is unclear. We aimed to explore the dynamic changes and potential classifications of NR over time using trajectory analysis and to investigate its relationship with the short-term prognosis of HIE.
We performed a retrospective analysis of medical records from patients at Shandong University Affiliated Children's Hospital from 2014 to 2022. NR trajectories were modeled in 605 HIE infants using latent growth mixture modeling from 0 to 4 weeks. Then using logistic regression analyze the relationship between NR trajectories and the short-term outcome of HIE. Finally, restricted cubic spline regression model were used to assess the nonlinear relationship between baseline NR and the outcome.
Two distinct NR trajectories could be modeled, a descending (class 1) and a ascending group (class 2). The ascending group (class 2) was associated with the poor outcome (OR 5.72, 95% CI 2.97-10.87, < 0.001; OR 4.78, 95% CI 2.42-9.28, < 0.001). A significant nonlinear relationship between NR and the risk of poor outcomes ( = 13.16, < 0.001), potentially exhibiting a U-shaped relationship.
The ascending NR group was strongly associated with poorer short-term outcomes. And both low and high NRs at baseline were associated with increased risk of poorer short-term outcomes.
围产期缺氧缺血性脑病（HIE）是一种死亡率和发病率都很高的疾病。中性粒细胞比率（NR）作为一项关键指标，在临床实践中被广泛应用。然而，动态变化的NR与HIE短期预后之间的关系尚不清楚。我们旨在通过轨迹分析探讨NR随时间的动态变化及潜在分类，并研究其与HIE短期预后的关系。
我们对山东大学附属儿童医院2014年至2022年患者的病历进行了回顾性分析。使用潜在增长混合模型对605例HIE婴儿从0至4周的NR轨迹进行建模。然后使用逻辑回归分析NR轨迹与HIE短期结局之间的关系。最后，使用受限立方样条回归模型评估基线NR与结局之间的非线性关系。
可以模拟出两种不同的NR轨迹，一种是下降型（1类）和一种上升型（2类）。上升型（2类）与不良结局相关（比值比5.72，95%置信区间2.97 - 10.87，P < 0.001；比值比4.78，95%置信区间2.42 - 9.28，P < 0.001）。NR与不良结局风险之间存在显著的非线性关系（P = 13.16，P < 0.001），可能呈现U型关系。
NR上升组与较差的短期结局密切相关。基线时低NR和高NR均与较差短期结局的风险增加相关。
