摘要
目的探讨入ICU时中性粒细胞与淋巴细胞比率(NLR)预测心跳骤停(CA)患者死亡率的价值。方法本研究是采用最新版本的重症监护数据库(MIMIC-Ⅲv1.4)进行的一项回顾性队列研究。分析2001年6月—2012年10月首次进入ICU的成人CA患者(≥18岁),并由相关资质人员提取临床数据。主要结局指标为ICU、28天全因死亡率。依据三分位数法将NLR分成3组,即<7.00、7.00~13.60和≥13.60组。比较3组间患者一般临床资料进行比较,运用Kaplan-Meier法绘制28天累积生存率曲线,并用log-rank分析加以检验。同时,建立多因素Cox回归分析模型,以分析CA患者28天全因死亡率的独立危险因素。结果本研究最终纳入593例成人CA患者,其中ICU住院期间、28天CA患者全因死亡率分别为34.74%和46.37%。各组CA患者间NLR、SOFA评分、碱剩余、白细胞、血小板和28天全因死亡率等指标差异有统计学意义(均P<0.05),其余各项指标之间差异均无统计学意义(均P>0.05)。KM生存曲线示3组CA患者28天累计生存率之间差异无统计学意义(log-rank检验,χ^(2)=5.900,P=0.052)。单因素Cox回归分析表明增高的NLR(≥13.60)是CA患者28天全因死亡率的危险因素。即使在控制了相关混杂因素后,多因素Cox回归模型仍支持这一结果。结论NLR的升高(≥13.60)与CA患者不良预后相关,其是此类患者28天全因死亡率的独立预测因子。NLR可作为一种新型的临床生物标志物,监测NLR的变化在评估CA患者预后方面有重要的临床应用价值。
Objective To evaluate the use of neutrophil-lymphocyte ratio(NLR)upon admission to an intensive care unit(ICU)in predicting mortality amongst patients who suffered cardiac arrest(CA).Methods This study was a retrospective cohort study using the latest version of the Intensive Care Database(MIMIC-III v1.4).Adult CA patients(≥18 years old)admitted to the ICU for the first time from June 2001 to October 2012 were analysed,and clinical data were extracted by relevant qualified personnel.The primary endpoints were as follows:ICU and 28-day all-cause mortality.NLR was divided into three groups in accordance with tertiles,defined by ranges of<7.00,7.00-13.60 and≥13.60.The related clinical data of these patients were analysed based on those three groups.Survival analyses were carried out to analyse the ICU and 28-day cumulative survival rates in these groups by using the Kaplan-Meier curves and log-rank test.Meanwhile,the Cox proportional hazard models were used to identify independent predictors of 28-day all-cause mortality amongst CA patients.Results A total of 593 adult participants with CA were involved in our study.The ICU and 28-day all-cause mortality of CA patients were 34.74%and 46.37%,respectively.Except for the remaining indicators,the variables of NLR,SOFA score,buffer excess,white blood cells,platelets and 28-day all-cause mortality showed significant differences amongst these three groups(all P<0.05).Kaplan-Meier analysis revealed that the difference in the cumulative survival rate of the 28 days was no significant(log-rank test,χ^(2)=5.900,P=0.052).The univariate Cox proportional hazard model showed that an increased level of NLR(≥13.60)was a risk factor for 28-day all-cause mortality in CA patients.This result was still supported by the multivariate Cox proportional hazard models analysis,even after controlling for the confounders.Conclusion An elevated NLR(≥13.60)is associated with poor prognosis for CA patients,and it can be used as an independent predictor for risk of 28-day all-cause mortali
作者
姚锐
姬晓伟
钟磊
王海丽
谢波
YAO Rui;JI Xiao-wei;ZHONG Lei;WANG Hai-li;XIE Bo(Department of Intensive Care Unit,Huzhou Central Hospital,Affiliated Central Hospital of Huzhou University,Huzhou,Zhejiang 313000,China;不详)
出处
《中华全科医学》
2022年第6期944-947,共4页
Chinese Journal of General Practice
基金
浙江省自然科学基金项目(LGD20H150001)。
