The neutrophil-lymphocyte ratio to predict poor prognosis of critical acute myocardial infarction patients: a retrospective cohort study.
The neutrophil-lymphocyte ratio to predict poor prognosis of critical acute myocardial infarction patients: a retrospective cohort study.
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中性粒细胞-淋巴细胞比值预测危重急性心肌梗死患者不良预后：一项回顾性队列研究
DOI：
10.11613/bm.2023.010702
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发表时间：
2023-02-15
期刊：
影响因子：
3.3
通讯作者：
Li, Xinming
中科院分区：
文献类型：
--
作者：
Wang, Wenhui;Liu, Linlin;Ning, Zhongping;Che, Lin;Li, Xinming
炎症与急性心肌梗死（AMI）的不良结局密切相关。本研究旨在探讨嗜中性淋巴细胞比率（NLR）能否预测危重急性心肌梗死患者的不良预后。我们设计了一项回顾性队列研究，并从“重症监护医学信息市场-III”数据库中提取AMI患者。主要结局为1年全因死亡率。次要结局为90天和院内全因死亡率以及急性肾损伤（阿基）发生率。通过X-tile软件根据1年死亡率选择NLR的最佳临界值，并创建患者组：低NLR（< 4.8），高NLR（4.8 - 21.1）和极高NLR（> 21.1）。采用考克斯和改良Poisson回归模型评价NLR对危重AMI患者预后的影响。最终，782例危重AMI患者入组本研究，1年死亡率为32%（249/782）。高NLR组和极高NLR组的结局发生率高于低NLR组（P < 0.05）。多变量回归分析发现，高NLR和极高NLR组的1年死亡率风险较高（风险比（HR）= 1.59，95% CI：1.12 - 2.24，P = 0.009和HR = 1.73，95% CI：1.09 - 2.73，P = 0.020），90天死亡率（HR = 1.69，95% CI：1.13 - 2.54，P = 0.011和HR = 1.90，95% CI：1.13 - 3.20，P = 0.016），住院死亡率（相对风险（RR）= 1.77，95% CI：1.14至2.74，P = 0.010和RR = 2.10，95% CI：1.23至3.58，P = 0.007），阿基发生率（RR = 1.44，95%CI：1.06 ~ 1.95，P = 0.018和RR = 1.34，95%CI：0.87 ~ 2.07，P = 0.180）。NLR在敏感性分析中保持稳定的预测能力。基线NLR是AMI患者1年死亡率、90天死亡率、住院死亡率和阿基发生率的独立风险因素。
Inflammation is closely related to adverse outcomes of acute myocardial infarction (AMI). This study aimed to evaluate whether neutrophil-lymphocyte ratio (NLR) can predict poor prognosis of critical AMI patients. We designed a retrospective cohort study and extracted AMI patients from the “Medical Information Mart for Intensive Care-III” database. The primary outcome was 1-year all-cause mortality. The secondary outcomes were 90-day and in-hospital all-cause mortalities, and acute kidney injury (AKI) incidence. The optimal cut-offs of NLR were picked by X-tile software according to the 1-year mortality and patient groups were created: low-NLR (< 4.8), high-NLR (4.8 - 21.1), and very high-NLR (> 21.1). Cox and modified Poisson regression models were used to evaluate the effect of NLR on outcomes in critically AMI patients. Finally, 782 critical AMI patients were enrolled in this study, and the 1-year mortality was 32% (249/782). The high- and very high-NLR groups had a higher incidence of outcomes than the low-NLR group (P < 0.05). The multivariate regression analyses found that the high- and very high-NLR groups had a higher risk of 1-year mortality (Hazard ratio (HR) = 1.59, 95% CI: 1.12 to 2.24, P = 0.009 and HR = 1.73, 95% CI: 1.09 to 2.73, P = 0.020), 90-day mortality (HR = 1.69, 95% CI: 1.13 to 2.54, P = 0.011 and HR = 1.90, 95% CI: 1.13 to 3.20, P = 0.016), in-hospital mortality (Relative risk (RR) = 1.77, 95% CI: 1.14 to 2.74, P = 0.010 and RR = 2.10, 95% CI: 1.23 to 3.58, P = 0.007), and AKI incidence (RR = 1.44, 95% CI: 1.06 to 1.95, P = 0.018 and RR = 1.34, 95% CI: 0.87 to 2.07, P = 0.180) compared with low-NLR group. NLR retained stable predictive ability in sensitivity analyses. Baseline NLR is an independent risk factor for 1-year mortality, 90-day mortality, in-hospital mortality, and AKI incidence in AMI patients.