Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections.
Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections.
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DOI：
10.3389/fneur.2020.574280
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发表时间：
2020
影响因子：
3.4
通讯作者：
Zhu S
中科院分区：
文献类型：
--
作者：
Lan Y;Sun W;Chen Y;Miao J;Li G;Qiu X;Song X;Zhao X;Zhu Z;Fan Y;Zhu S
中风一直是中国人死亡的主要原因。中风相关感染 (SAI) 是常见并发症，发生于 5-65% 的中风患者中。面对SAI，临床医生常常陷入相当的困境。一方面，预防性过度使用抗生素会导致耐药细菌的出现。另一方面，感染的治疗延迟可能会导致不良结果。因此，有必要确定脑卒中后感染的早期预测因素，筛选高感染风险患者，进行早期临床干预，从而促进和提高生存率。我们评估了连续回顾性队列中的 257 名急性缺血性中风患者。这些患者的数据是从2018年8月至2019年6月期间从三家医院（同济医院及其两家分院）获得的。这些患者中，59例（23.0%）发生了SAI。 SAI 是根据修改后的疾病控制和预防中心标准定义的。出现肺炎38例（64.4%），尿路感染11例（18.6%），其他感染10例（16.9%）。我们发现中性粒细胞与淋巴细胞的比率较高（调整后优势比 [aOR] = 1.16；95% 置信区间 [CI]，1.01–1.33；P = 0.034）、美国国立卫生研究院卒中量表评分（aOR = 1.18；CI，1.09–1.27；p < 0.001）和吞咽困难（aOR = 2.95；CI，1.40-6.22；P = 0.004）是 SAI 的危险因素。值得注意的是，高甘油三酯血症（aOR = 0.35；CI，0.13-0.90；P = 0.029）是一个保护因素，可降低 SAI 的风险。为此，我们的研究中构建了可靠的列线图来预测 SAI（平均 C 指数值±标准差 = 0.821 ± 0.03）。它具有广泛应用的潜力，可能有助于识别 SAI 高风险患者并及时做出临床决策。鉴于我们的研究基于相对较小的数据集，因此应谨慎解释结果，并且在独立数据集中进行外部验证是非常必要的。
Stroke has been a leading cause of mortality in China. Stroke-associated infections (SAI) are common complications, occurring in 5–65% of stroke patients. Faced with SAI, clinicians often are placed in a considerable dilemma. On the one hand, preventive overuse of antibiotics will lead to the emergence of drug-resistant bacteria. On the other hand, treatment delay of the infection will likely result in a poor outcome. Therefore, it is necessary to determine the early predictors of post-stroke infection to screen patients with high infection risk for early clinical intervention, thereby promoting and improving survival rates. We assessed 257 patients with acute ischemic stroke from a consecutive retrospective cohort. Data of these patients were obtained from three hospitals (TongJi Hospital and its two branches) between August 2018 and June 2019. Of these patients, 59 (23.0%) developed SAI. SAI was defined according to the modified Centers for Disease Control and Prevention criteria. There were 38 patients (64.4%) who developed pneumonia, 11 with urinary tract infections (18.6%), and 10 with other infections (16.9%). We found that a higher neutrophil-to-lymphocyte ratio (adjusted odds ratio [aOR] = 1.16; 95% confidence interval [CI], 1.01–1.33; P = 0.034), National Institutes of Health Stroke Scale score (aOR = 1.18; CI, 1.09–1.27; p < 0.001), and dysphagia (aOR = 2.95; CI, 1.40–6.22; P = 0.004) were risk factors for SAI. Of note, hypertriglyceridemia (aOR = 0.35; CI, 0.13–0.90; P = 0.029) was a protective factor, lowering the risk of SAI. To this end, a reliable nomogram was constructed for the prediction of SAI in our study (mean C-index value ± standard deviation = 0.821 ± 0.03). It has the potential to be widely used and may help identify patients at high risk for SAI and make timely clinical decisions. Given our study was based on relatively small dataset, the results should be interpreted with care and external validation in independent datasets is very necessary.
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影响因子：
3.5
作者：
Kwan, J.;Hand, P.
通讯作者：
Hand, P.
影响因子：
8.3
作者：
Nam, Ki-Woong;Kim, Tae Jung;Yoon, Byung-Woo
通讯作者：
Yoon, Byung-Woo
影响因子：
8.3
作者：
Hoffmann, Sarah;Malzahn, Uwe;Heuschmann, Peter Ulrich
通讯作者：
Heuschmann, Peter Ulrich
影响因子：
2.6
作者：
Li, Yang;Zhang, Yu;Chang, Junsen
通讯作者：
Chang, Junsen
DOI：
10.1016/s1470-2045(14)71116-7
发表时间：
2015-04
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Balachandran VP;Gonen M;Smith JJ;DeMatteo RP
通讯作者：
DeMatteo RP