Tao Liu, Bing Wang, Shengjue Xiao, Lifang Sun, Zhijian Zhu, Shasha Wang, Baoyin Li, Jianhui Yao, Conggang Huang, Wei Ge, Lei Qian, Zhigang Lu, Yesheng Pan
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引用次数: 2
摘要
目的:研究急性心力衰竭(AHF)患者入院时中性粒细胞与淋巴细胞比值(NLR)与预后不良之间的关系。然而，AHF患者NLR的动态变化与住院死亡率之间的关系尚未得到研究。我们的目的是确定AHF患者入住重症监护病房(ICU)后第一周内NLR的早期变化是否与院内死亡率相关。方法:对重症监护医学信息市场(MIMIC-IV)数据库中的数据进行分析。采用平滑曲线拟合和多变量logistic回归分析评估基线NLR对AHF危重患者住院死亡率的影响。此外，使用广义加性混合模型(GAMM)比较幸存者和非幸存者NLR的动态变化。结果:共有1169名参与者参加了本研究，其中986人为住院幸存者，183人为住院非幸存者。平滑曲线拟合显示基线NLR与住院死亡率呈正相关，多变量logistic回归分析显示基线NLR是住院死亡率的独立危险因素(OR 1.04, 95% CI 1.02,1.07, p值= 0.001)。在调整混杂因素后，GAMM显示，在ICU入院后的第一周，幸存者和非幸存者之间的NLR差异逐渐增加，差异平均每天增加0.51 (β = 0.51, 95% CI 0.45-0.56, p值结论:基线NLR与AHF危重患者预后不良相关。早期NLR的升高与较高的住院死亡率有关，这表明跟踪NLR的早期变化可能有助于确定AHF危重患者的短期预后。
Correlation analysis between the static and the changed neutrophil-to-lymphocyte ratio and in-hospital mortality in critical patients with acute heart failure.
Objective: Association between neutrophil-to-lymphocyte ratio (NLR) on admission and poor prognosis in patients with acute heart failure (AHF) has been well established. However, the relationship between dynamic changes in NLR and in-hospital mortality in AHF patients has not been studied. Our purpose was to determine if an early change in NLR within the first week after AHF patients was admitted to intensive care unit (ICU) was associated with in-hospital mortality.
Methods: Data from the medical information mart for intensive care IV (the MIMIC-IV) database was analyzed. The effect of baseline NLR on in-hospital mortality in critical patients with AHF was evaluated utilizing smooth curve fitting and multivariable logistic regression analysis. Moreover, comparison of the dynamic change in NLR among survivors and non-survivors was performed using the generalized additive mixed model (GAMM).
Results: There were 1169 participants who took part in the present study, 986 of whom were in-hospital survivors and 183 of whom were in-hospital non-survivors. The smooth curve fitting revealed a positive relationship between baseline NLR and in-hospital mortality, and multivariable logistic regression analysis indicated that baseline NLR was an independent risk factor for in-hospital mortality (OR 1.04, 95% CI 1.02,1.07, P-value = 0.001). After adjusting for confounders, GAMM showed that the difference in NLR between survivors and non-survivors grew gradually during the first week after ICU admission, and the difference grew by an average of 0.51 per day (β = 0.51, 95% CI 0.45-0.56, P-value <0.001).
Conclusions: Baseline NLR was associated with poor prognosis in critical patients with AHF. Early rises in NLR were linked to higher in-hospital mortality, which suggests that keeping track of how NLR early changes might help identify short-term prognosis of critical patients with AHF.
期刊介绍：
Postgraduate Medicine is a rapid peer-reviewed medical journal published for physicians. Tracing its roots back to 1916, Postgraduate Medicine was established by Charles Mayo, MD, as a peer-to-peer method of communicating the latest research to aid physicians when making treatment decisions, and it maintains that aim to this day. In addition to its core subscriber base, Postgraduate Medicine is distributed to hundreds of US-based physicians within internal medicine and family practice.
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