Neutrophil-to-Lymphocyte Ratios and Infections after Traumatic Brain Injury: Associations with Hospital Resource Utilization and Long-Term Outcome.
Neutrophil-to-Lymphocyte Ratios and Infections after Traumatic Brain Injury: Associations with Hospital Resource Utilization and Long-Term Outcome.
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DOI：
10.3390/jcm10194365
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发表时间：
2021-09-24
影响因子：
3.9
通讯作者：
Wagner A
中科院分区：
文献类型：
--
作者：
Levochkina M;McQuillan L;Awan N;Barton D;Maczuzak J;Bianchine C;Trombley S;Kotes E;Wiener J;Wagner A;Calcagno J;Maza A;Nierstedt R;Ferimer S;Wagner A
创伤性脑损伤引起免疫功能障碍，临床表现为中性粒细胞/淋巴细胞比率(NLR)升高。然而，很少有研究描述颅脑损伤后NLR的时间动态及其与医院获得性感染(HAI)、资源利用或结果的关系。我们使用基于群体的轨迹(TRAJ)、变点和混合效应多变量回归分析，评估了中重度颅脑损伤(n=196)成人伤后前21天的NLR和HAI，以表征时间动力学。我们确定了两组具有独特NLR特征的组：高TRAJ组(n=67)和低TRAJ组(n=129)。NLRTRAJ越高，感染率越高(76.12%vs.55.04%，p=0.004)，感染时间越早(p=0.003)。在变化点衍生的第0-5和6-20个时期，恢复早期淋巴细胞TRAJ低导致更频繁的HAI(p=0.042)，随后NLR值升高(p≤0.0001)。在多变量回归分析中，高NLRTRAJ和HAI均增加住院时间(LOS)和机械通气天数(p≤0.05)，而仅高NLRTRAJ显著增加格拉斯哥预后量表(GOS)衡量的不良6个月预后的几率(p=0.046)。这些发现提供了对免疫因素的时间动态和相互关联的洞察，这些因素共同影响感染的易感性和更大的医院资源利用率，以及影响康复。
Traumatic brain injury (TBI) induces immune dysfunction that can be captured clinically by an increase in the neutrophil-to-lymphocyte ratio (NLR). However, few studies have characterized the temporal dynamics of NLR post-TBI and its relationship with hospital-acquired infections (HAI), resource utilization, or outcome. We assessed NLR and HAI over the first 21 days post-injury in adults with moderate-to-severe TBI (n = 196) using group-based trajectory (TRAJ), changepoint, and mixed-effects multivariable regression analysis to characterize temporal dynamics. We identified two groups with unique NLR profiles: a high (n = 67) versus a low (n = 129) TRAJ group. High NLR TRAJ had higher rates (76.12% vs. 55.04%, p = 0.004) and earlier time to infection (p = 0.003). In changepoint-derived day 0–5 and 6–20 epochs, low lymphocyte TRAJ, early in recovery, resulted in more frequent HAIs (p = 0.042), subsequently increasing later NLR levels (p ≤ 0.0001). Both high NLR TRAJ and HAIs increased hospital length of stay (LOS) and days on ventilation (p ≤ 0.05 all), while only high NLR TRAJ significantly increased odds of unfavorable six-month outcome as measured by the Glasgow Outcome Scale (GOS) (p = 0.046) in multivariable regression. These findings provide insight into the temporal dynamics and interrelatedness of immune factors which collectively impact susceptibility to infection and greater hospital resource utilization, as well as influence recovery.
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目前对创伤和感染免疫反应机制的看法。
DOI：
10.5114/ceji.2015.52835
发表时间：
2015
期刊：
Central-European journal of immunology
影响因子：
--
作者：
Binkowska AM;Michalak G;Słotwiński R
通讯作者：
Słotwiński R
影响因子：
2.4
作者：
Chen, Weiqiang;Yang, Jinhua;Wang, Shousen
通讯作者：
Wang, Shousen
DOI：
10.1097/00005373-197403000-00001
发表时间：
1974-01-01
影响因子：
--
作者：
BAKER, SP;ONEILL, B;LONG, WB
通讯作者：
LONG, WB
影响因子：
3.6
作者：
Clark, RSB;Kochanek, PM;Watkins, SC
通讯作者：
Watkins, SC
影响因子：
8.8
作者：
Doran SJ;Henry RJ;Shirey KA;Barrett JP;Ritzel RM;Lai W;Blanco JC;Faden AI;Vogel SN;Loane DJ
通讯作者：
Loane DJ