Fakiha Siddiqui, Alfonso Tafur, Mushtaq Hussain, Alberto García-Ortega, Amir Darki, Jawed Fareed, David Jiménez, Behnood Bikdeli, Francisco Galeano-Valle, José Luis Fernández-Reyes, Montserrat Pérez-Pinar, Manuel Monreal, the RIETE Investigators
{"title":"肺栓塞患者血细胞指数的预后价值。","authors":"Fakiha Siddiqui, Alfonso Tafur, Mushtaq Hussain, Alberto García-Ortega, Amir Darki, Jawed Fareed, David Jiménez, Behnood Bikdeli, Francisco Galeano-Valle, José Luis Fernández-Reyes, Montserrat Pérez-Pinar, Manuel Monreal, the RIETE Investigators","doi":"10.1002/ajh.27379","DOIUrl":null,"url":null,"abstract":"<p>Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30-day all-cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty-day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60–4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77–3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90–3.33). The c-statistic for NLR in patients with low-risk PE was 0.78 (95% CI: 0.69–0.86). Respective numbers were 0.66 (95% CI: 0.63–0.69) and 0.68 (95% CI: 0.59–0.76) for intermediate-risk and high-risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5–98.7) and negative predictive value (99.7%; 95% CI: 99.5–99.8) than sPESI alone (87.1%; 95% CI: 83.9–90.3, and 98.7%; 95% CI: 98.4–99.1, respectively) for 30-day mortality. The NLR is a significant prognostic marker for 30-day mortality in PE patients, especially useful to identify patients with very low-risk PE.</p>","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":null,"pages":null},"PeriodicalIF":10.1000,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The prognostic value of blood cellular indices in pulmonary embolism\",\"authors\":\"Fakiha Siddiqui, Alfonso Tafur, Mushtaq Hussain, Alberto García-Ortega, Amir Darki, Jawed Fareed, David Jiménez, Behnood Bikdeli, Francisco Galeano-Valle, José Luis Fernández-Reyes, Montserrat Pérez-Pinar, Manuel Monreal, the RIETE Investigators\",\"doi\":\"10.1002/ajh.27379\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30-day all-cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty-day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60–4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77–3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90–3.33). The c-statistic for NLR in patients with low-risk PE was 0.78 (95% CI: 0.69–0.86). Respective numbers were 0.66 (95% CI: 0.63–0.69) and 0.68 (95% CI: 0.59–0.76) for intermediate-risk and high-risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5–98.7) and negative predictive value (99.7%; 95% CI: 99.5–99.8) than sPESI alone (87.1%; 95% CI: 83.9–90.3, and 98.7%; 95% CI: 98.4–99.1, respectively) for 30-day mortality. The NLR is a significant prognostic marker for 30-day mortality in PE patients, especially useful to identify patients with very low-risk PE.</p>\",\"PeriodicalId\":7724,\"journal\":{\"name\":\"American Journal of Hematology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":10.1000,\"publicationDate\":\"2024-05-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Hematology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ajh.27379\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Hematology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ajh.27379","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}
The prognostic value of blood cellular indices in pulmonary embolism
Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30-day all-cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty-day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60–4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77–3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90–3.33). The c-statistic for NLR in patients with low-risk PE was 0.78 (95% CI: 0.69–0.86). Respective numbers were 0.66 (95% CI: 0.63–0.69) and 0.68 (95% CI: 0.59–0.76) for intermediate-risk and high-risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5–98.7) and negative predictive value (99.7%; 95% CI: 99.5–99.8) than sPESI alone (87.1%; 95% CI: 83.9–90.3, and 98.7%; 95% CI: 98.4–99.1, respectively) for 30-day mortality. The NLR is a significant prognostic marker for 30-day mortality in PE patients, especially useful to identify patients with very low-risk PE.
期刊介绍:
The American Journal of Hematology offers extensive coverage of experimental and clinical aspects of blood diseases in humans and animal models. The journal publishes original contributions in both non-malignant and malignant hematological diseases, encompassing clinical and basic studies in areas such as hemostasis, thrombosis, immunology, blood banking, and stem cell biology. Clinical translational reports highlighting innovative therapeutic approaches for the diagnosis and treatment of hematological diseases are actively encouraged.The American Journal of Hematology features regular original laboratory and clinical research articles, brief research reports, critical reviews, images in hematology, as well as letters and correspondence.