Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients
Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients
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DOI：
10.1016/j.ajem.2016.10.055
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发表时间：
2017-02-01
影响因子：
3.6
通讯作者：
Sim, Min Seob
中科院分区：
文献类型：
--
作者：
Hwang, Sung Yeon;Shin, Tae Gun;Sim, Min Seob
背景：我们评估了脓毒症患者中性粒细胞与淋巴细胞比率（NLR）或 NLR 变化与预后之间的关联。方法：根据初始 NLR 值的五分位数将符合严重脓毒症或脓毒性休克标准的患者分为五组。我们根据NLR值和前两天NLR的变化定义了两个风险组（定义为持续低NLR组和持续高NLR组）。主要结局是 28 天死亡率。结果：总共纳入 1395 名患者。从五分位 1 到五分位 5 的中位初始 NLR 值如下：02（IQR [四分位距]，0.1-0.7）、3.4（IQR，2.6-4.7）、8.6（IQR，7.1-9.9）、15.4（IQR，133-17.8）和 31.0（IQR，133-17.8）和 31.0（IQR，2.6-4.7）。 24.6-46.8），分别。同一组的 28 天死亡率如下：24.4%、12.2%、11.1%、11.8% 和 16.1% (P < .01)。 Cox 回归分析显示，与五分位数 3 相比，纳入五分位数 1 或五分位数 5 是预测 28 天死亡率的显着风险因素（调整后的风险比 [HR]：五分位数 1 中为 1.79（95% 置信区间 [Cl]，1.15-2.78）；五分位数 5 中为 1.67（95% CI，1.04-2.66））。分析表明，持续低NLR（调整后HR：2.25，95％CI，1.63-3.11）和持续高NLR（调整后HR：2.65，95％CI，1.64-4.29）是显着的危险因素。结论：综上所述，急诊室入院时测量的初始NLR与严重脓毒症和感染性休克患者的28天死亡率独立相关。此外，NLR 的变化可能被证明是一个有价值的预后标志。 (C) 2016 Elsevier Inc. 保留所有权利。
Background: We evaluated the associations between the neutrophil-to-lymphocyte ratio (NLR) or changes in NLR and outcomes in septic patients.Methods: Patients who met the criteria for severe sepsis or septic shock were categorized into five groups according to the quintile of initial NLR value. We defined two risk groups according to NLR value and changes in NLR during the first two days (defined as the persistently low NLR group and the persistently high NLR group). The primary outcome was 28-day mortality.Results: A total of 1395 patients were included. The median initial NLR values from Quintile 1 to Quintile 5 were as follows: 02 (IQR [interquartile range], 0.1-0.7), 3.4 (IQR, 2.6-4.7), 8.6 (IQR, 7.1-9.9), 15.4 (IQR, 133-17.8), and 31.0 (IQR, 24.6-46.8), respectively. The 28-day mortality values for the same groups were as follows: 24.4%, 12.2%, 11.1%, 11.8%, and 16.1% (P < .01). Cox regression analysis showed that inclusion in Quintile 1 or Quintile 5 was a significant risk factor predicting 28-day mortality compared to Quintile 3 (adjusted hazard ratio [HR]: 1.79 (95% confidence interval [Cl], 1.15-2.78) in Quintile 1; 1.67 (95% CI, 1.04-2.66) in Quintile 5). The analysis indicated that persistently low NLR (adjusted HR: 2.25, 95% CI, 1.63-3.11) and persistently high NLR (adjusted HR: 2.65, 95% CI, 1.64-4.29) were significant risk factors.Conclusions: In summary, the initial NLR measured at ED admission was independently associated with 28-day mortality in patients with severe sepsis and septic shock. In addition, change in NLR may prove to be a valuable prognostic marker. (C) 2016 Elsevier Inc. All rights reserved.