中性粒细胞与淋巴细胞比率对心跳骤停患者预后的评估价值

姚锐; 姬晓伟; 钟磊; 王海丽; 谢波

doi:10.16766/j.cnki.issn.1674-4152.002494

中性粒细胞与淋巴细胞比率对心跳骤停患者预后的评估价值

doi: 10.16766/j.cnki.issn.1674-4152.002494

姚锐¹,
姬晓伟¹,
钟磊¹,
王海丽²,
谢波^1, ,

1.
湖州市中心医院湖州师范学院附属中心医院重症医学科，浙江湖州 313000
2.
湖州市中心医院湖州师范学院附属中心医院妇产医学科

基金项目:

浙江省自然科学基金项目 LGD20H150001

详细信息

通讯作者:
谢波, E-mail: wxystcd@163.com

中图分类号: R541.78R446.113
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- 被引次数: 0
出版历程
- 收稿日期: 2021-09-11
- 网络出版日期: 2022-09-21

The predictive value of neutrophil-lymphocyte ratio in the prognosis of patients with cardiac arrest

1.
Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang 313000, China

摘要

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-Ⅲ v1.4)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，χ²=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。
- 中性粒细胞与淋巴细胞比率 /
- 心跳骤停 /
- 回顾性队列研究
Abstract: 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, χ²=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 mortality. In conclusion, as a novel prognostic marker in CA patients, monitoring the changes in NLR have important clinical value in assessing the prognosis of these patients.
- Neutrophil-lymphocyte ratio /
- Cardiac arrest /
- Retrospective cohort study

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图 1 3组患者28天累计生存率Kaplan-Meier生存曲线

注：NLR为中性粒细胞和淋巴细胞比率。

Figure 1. Kaplan-Meier curve of 28-day cumulative survival rates among the three groups

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表 1 不同NLR分组ICU患者一般情况比较

Table 1. Comparison of baseline characteristics of ICU patients in three different NLR groups

项目	整体人群(n=593)	NLR			统计量	P值
项目	整体人群(n=593)	< 7.00(n=197)	7.00~13.60(n=198)	≥13.60(n=198)	统计量	P值
年龄(x±s，岁)	66.40±15.79	65.49±14.33	65.58±16.67	68.14±16.19	1.800^a	0.166
女性[例(%)]	205(34.57)	69(35.03)	62(31.31)	74(37.37)	1.635^b	0.442
NLR[M(P₂₅, P₇₅)]	9.61(5.92，17.09)	4.69(3.46，5.92)	9.61(8.04，11.71)	20.30(17.09，30.16)	526.225^c	＜0.001
SOFA评分(x±s, 分)	6.46±3.67	5.88±3.58	6.69±3.50	6.81±3.87	3.780^b	0.023
BE[M(P₂₅, P₇₅), mmol/L]	-2(-6，0)	-1(-5，1)	-3(-6，0)	-3(-7，0)	10.731^c	0.005
乳酸[M(P₂₅, P₇₅)，mmol/L]	2.4(1.6，4.2)	2.4(1.4，3.5)	2.4(1.7，4.3)	2.4(1.6，4.5)	2.978^c	0.226
动脉血氧分压(x±s，mm Hg)	185.10±118.25	190.87±119.36	185.01±122.74	179.44±112.75	0.460^a	0.631
白细胞(x±s，×10⁹/L)	14.22±7.34	12.02±6.60	14.09±7.09	16.53±7.62	19.890^a	＜0.001
血红蛋白(x±s，g/L)	113.45±23.60	111.91±21.81	114.62±25.80	113.81±23.05	0.680^a	0.506
血小板(x±s，×10⁹/L)	225.89±111.42	216.65±107.96	212.10±99.90	248.87±122.16	6.520^a	0.002
血糖(x±s，mmol/L)	10.28±5.63	9.87±5.46	10.67±6.23	10.32±5.16	0.980^a	0.376
肌酐[M(P₂₅, P₇₅)，μmol/L]	106.08(70.72, 159.12)	88.40(70.72, 141.44)	106.08(79.56, 176.80)	114.92(79.56, 167.96)	5.765^c	0.055
血钾(x±s，mmol/L)	4.30±0.85	4.24±0.87	4.27±0.81	4.39±0.86	1.800^a	0.167
血钙(x±s，mmol/L)	2.05±0.25	2.06±0.23	2.05±0.27	2.05±0.24	0.030^a	0.973
血磷(x±s，mg/dL)	1.23±0.51	1.21±0.51	1.20±0.49	1.28±0.54	1.260^a	0.283
合并症[例(%)]
高血压	226(38.11)	79(40.10)	75(37.88)	72(36.36)	0.592^b	0.744
糖尿病	187(31.53)	51(25.89)	71(35.86)	65(32.83)	4.777^b	0.092
冠心病	218(36.76)	76(38.58)	75(37.88)	67(33.84)	1.114^b	0.573
急性心肌梗死	81(13.66)	28(14.21)	33(16.67)	20(10.10)	3.695^b	0.158
急性呼吸衰竭	239(40.30)	70(35.53)	82(41.41)	87(43.94)	3.053^b	0.217
ICU住院时间[M(P₂₅, P₇₅), d]	6.17(3.12，12.19)	5.42(2.79，10.99)	6.54(3.05，11.37)	7.16(3.32，13.94)	5.408^c	0.067
住院时间[M(P₂₅, P₇₅), d]	11.96(6.13，21.63)	11.96(6.29，20.21)	10.83(5.88，20.88)	13.44(6.25，23.75)	2.763^c	0.251
ICU全因死亡率[例(%)]	206(34.74)	59(29.95)	71(35.86)	76(38.38)	3.263^b	0.196
28天ICU全因死亡率[例(%)]	275(46.37)	79(40.10)	90(45.45)	106(53.54)	7.267^b	0.026
注：^a为F值，^b为χ²值，^c为H值。1 mm Hg=0.133 kPa。

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表 2 3组患者间28天全因死亡率的Cox回归分析

Table 2. The Cox proportional hazard regression analysis of 28-day all-cause mortality among the three groups of cardiac arrest patients

风险模型	组别	B	SE	Wald χ²	P值	HR值	95% CI
模型1	< 7.00	基线		5.846
	7.00~13.60	-0.359	0.149	5.835	0.212	1.212	0.896~1.640
	≥13.60	-0.167	0.143	1.354	0.016	1.432	1.070~1.917
模型2	< 7.00	基线		5.130
	7.00~13.60	-0.337	0.149	5.125	0.233	1.202	0.888~1.626
	≥13.60	-0.153	0.144	1.142	0.024	1.401	1.046~1.877
模型3	< 7.00	基线		4.742
	7.00~13.60	0.201	0.158	1.623	0.203	1.223	0.897~1.666
	≥13.60	0.343	0.158	4.740	0.029	1.410	1.035~1.921
注：模型1未调整；模型2调整了年龄、性别等因素；模型3在模型2的基础上调整了白细胞、血小板、肌酐、碱剩余、SOFA评分、糖尿病、心肌梗死及ICU住院时间等因素。

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参考文献(20)

[1]	PARATZ E D, ROWSELL L, ZENTNER D, et al. Cardiac arrest and sudden cardiac death registries: A systematic review of global coverage[J]. Open Heart, 2020, 7(1): e001195. DOI: 10.1136/openhrt-2019-001195.
[2]	CHOI D S, SHIN S D, RO Y S, et al. Relationship between serum potassium level and survival outcome in out-of-hospital cardiac arrest using CAPTURES database of Korea: Does hypokalemia have good neurological outcomes in out-of-hospital cardiac arrest?[J]. Adv Clin Exp Med, 2020, 29(6): 727-734. doi: 10.17219/acem/122178
[3]	GRANGER C B, HANSEN C M. Predicting outcome in cardiac arrest: Some progress, but more work needed[J]. Eur Heart J, 2020, 41(47): 4518-4520. doi: 10.1093/eurheartj/ehaa673
[4]	顾伟, 李春盛. 心脏骤停后综合征: 类脓毒症样综合征[J]. 中华急诊医学杂志, 2019, 28(1): 121-123. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY202107010.htm GU W, LI C S. Post-cardiac arrest syndrome: Sepsis-like syndrome[J]. Chinese Journal of Emergency Medicine, 2019, 28(1): 121-123. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY202107010.htm
[5]	GARDNER R, LIU X W, WANG Y B, et al. Vitamin C levels amongst initial survivors of out of hospital cardiac arrest[J]. Resuscitation, 2020, 156: 190-193. doi: 10.1016/j.resuscitation.2020.09.005
[6]	JOU C, SHAH R, FIGUEROA A, et al. The Role of inflammatory cytokines in cardiac arrest[J]. J Intensive Care Med, 2020, 35(3): 219-224. doi: 10.1177/0885066618817518
[7]	BRO-JEPPESEN J, KJAERGAARD J, WANSCHER M, et al. Systemic inflammatory response and potential prognostic implications after out-of-hospital cardiac arrest: A substudy of the target temperature management trial[J]. Crit care med, 2015, 43(6): 1223-1232. doi: 10.1097/CCM.0000000000000937
[8]	PATEL V H, VENDITTELLI P, GARG R, et al. Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest[J]. World J Crit Care Med, 2019, 8(2): 9-17. doi: 10.5492/wjccm.v8.i2.9
[9]	钱少环, 李妙男, 姚卓亚, 等. 中性粒细胞与淋巴细胞比值联合C反应蛋白对急性冠脉综合征患者预后的预测价值[J]. 中华全科医学, 2020, 18(10): 1621-1624, 1628. doi: 10.16766/j.cnki.issn.1674-4152.001576 QIAN S H, LI M N, YAO Z Y, et al. Prognostic value of neutrophil to lymphocyte ratio combined with C-reactive protein in patients with acute coronary syndrome[J]. Chinese Journal of General Practice, 2020, 18(10): 1621-1624, 1628. doi: 10.16766/j.cnki.issn.1674-4152.001576
[10]	SOULAIMAN S E, DOPA D, RAAD A T, et al. Cohort retrospective study: The neutrophil to lymphocyte ratio as an independent predictor of outcomes at the presentation of the multi-trauma patient[J]. Int J Emerg Med, 2020, 13(1): 5. doi: 10.1186/s12245-020-0266-3
[11]	KURI-CERVANTES L, PAMPENA M B, MENG W, et al. Comprehensive mapping of immune perturbations associated with severe COVID-19[J]. Sci Immunol, 2020, 5(49) : eabd7114. doi: 10.1126/sciimmunol.abd7114
[12]	GAMEIRO J, FONSECA J A, JORGE S, et al. Neutrophil, lymphocyte and platelet ratio as a predictor of mortality in septic-acute kidney injury patients[J]. Nefrologia, 2020, 40(4): 461-468. doi: 10.1016/j.nefro.2019.11.006
[13]	梁欢, 高烨, 苗常青, 等. 中性粒细胞/淋巴细胞比值对重症肺炎患者28 d死亡风险的预测价值[J]. 中华危重病急救医学, 2019, 31(7): 827-831. doi: 10.3760/cma.j.issn.2095-4352.2019.07.006 LIANG H, GAO Y, MIAO C Q, et al. Predictive value of neutrophil to lymphocyte ratio on 28-day mortality of patients with severe pneumonia[J]. Chinese Critical Care Medicine, 2019, 31(7): 827-831. doi: 10.3760/cma.j.issn.2095-4352.2019.07.006
[14]	WEISER C, SCHWAMEIS M, STERZ F, et al. Mortality in patients resuscitated from out-of-hospital cardiac arrest based on automated blood cell count and neutrophil lymphocyte ratio at admission[J]. Resuscitation, 2017, 116: 49-55. doi: 10.1016/j.resuscitation.2017.05.006
[15]	潘萌萌, 宋维, 廖明喻, 等. 中性粒细胞/淋巴细胞比值在脓毒症中的研究进展[J]. 国际呼吸杂志, 2020, 40(1): 70-73. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201718013.htm PAN M M, SONG W, LIAO M Y, et al. Progress in the study of neutrophil-lymphocyte ratio in sepsis[J]. International Journal of Respiration, 2020, 40(1): 70-73. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201718013.htm
[16]	宋荟芬, 李虹伟, 赵树梅, 等. 中性粒细胞和淋巴细胞比率对急性冠状动脉综合征患者住院及长期死亡率的预测价值[J]. 中国心血管杂志, 2013, 18(3): 177-181. https://www.cnki.com.cn/Article/CJFDTOTAL-XIXG201303009.htm SONG H F, LI H W, ZHAO S M, et al. Predictive value of neutrophil to lymphocyte ratio for in-hospital and long-term mortality in patients with acute coronary syndrome[J]. Chinese Journal of Cardiovascular Medicine, 2013, 18(3): 177-181. https://www.cnki.com.cn/Article/CJFDTOTAL-XIXG201303009.htm
[17]	CHO J H, CHO H J, LEE H Y, et al. Neutrophil-lymphocyte ratio in patients with acute heart failure predicts in-hospital and long-term mortality[J]. J Clin Med, 2020, 9(2): 557. doi: 10.3390/jcm9020557
[18]	ZUIN M, RIGATELLI G, PICARIELLO C, et al. Correlation and prognostic role of neutrophil to lymphocyte ratio and SYNTAX score in patients with acute myocardial infarction treated with percutaneous coronary intervention: A six-year experience[J]. Cardiovasc Revasc Med, 2017, 18(8): 565-571. doi: 10.1016/j.carrev.2017.05.007
[19]	李超, 吴允孚, 刘军. 中性粒细胞/淋巴细胞、血小板/淋巴细胞预测心肺复苏术自主循环恢复患者预后的价值[J]. 徐州医科大学学报, 2019, 39(12): 893-898. https://www.cnki.com.cn/Article/CJFDTOTAL-XZYX201912010.htm LI C, WU Y F, LIU J. Predictive value of neutrophil/lymphocyte and platelet/lymphocyte on patients with spontaneous circulation recovery after cardiac arrest[J]. Journal of Xuzhou Medical University, 2019, 39(12): 893-898. https://www.cnki.com.cn/Article/CJFDTOTAL-XZYX201912010.htm
[20]	罗成准, 王世伟, 贾天元, 等. 心肺复苏后患者中性粒细胞与淋巴细胞比值与死亡的相关性研究[J]. 临床急诊杂志, 2020, 21(2): 143-146. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202002010.htm LUO C Z, WANG S W, JIA T Y, et al. Correlation between neutrophil-lymphocyte ratio and death in patients after cardiopulmonary resuscitation[J]. Journal of Clinical Emergency, 2020, 21(2): 143-146. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202002010.htm