联合入院时及出院前中性粒细胞/淋巴细胞比值对射血分数降低的心力衰竭患者长期全因死亡的预测价值

Predictive value of neutrophil-lymphocyte ratio on admission and before discharge for long-term all-cause death in hospitalized heart failure patients with reduced ejection fraction

目的评价入院时及出院前中性粒细胞/淋巴细胞比值(NLR)联合对住院的射血分数降低的心力衰竭(HFrEF)患者出院后长期全因死亡的预测价值。方法连续入选2013年1月至2017年12月于泰达国际心血管病医院心脏重症监护病房(CCU)住院的临床诊断为HFrEF且存活出院的患者,于入院1 d内及出院前3 d内检查血常规,计算NLR,采用多因素Cox比例回归模型分析入院时及出院前NLR联合对HFrEF患者出院后长期全因死亡的预测价值。存活出院患者随访至2020年12月或全因病死。结果共入选了368例HFrEF患者,年龄为(54±14)岁,女性79例(21.5%)。患者出院后随访时间的M(Q_(1),Q_(3))为30(10,60)个月,其间95例患者死亡,全因死亡率为25.8%。多因素Cox比例回归模型分析结果显示,在校正入院时收缩压水平、左心室舒张末期内径、出院时收缩压水平及出院时是否口服醛固酮受体拮抗剂等指标后,出院前NLR是住院HFrEF患者出院后长期全因死亡的独立预测因素之一(HR=1.143,95%CI:1.048~1.248,P=0.003)。与入院时NLR≤2.25且出院前NLR≤2.00患者比较,入院时NLR>2.25且出院前NLR>2.00患者出院后长期全因死亡增加近1倍(HR=1.968,95%CI:1.198~3.234,P=0.008)。结论出院前NLR是HFrEF住院患者出院后长期全因死亡的独立预测因素。联合入院时及出院前NLR有助于更好地评价患者出院后的全因死亡风险。

Objective To evaluate the predictive value of neutrophil-lymphocyte ratio(NLR)on admission and before discharge for long-term all-cause death(ACD)in patients hospitalized with heart failure with reduced ejection fraction(HFrEF).Methods Patients hospitalized and discharged from hospital alive with the clinical diagnosis of HFrEF in cardiac care unit(CCU)of TEDA International Cardiovascular Hospital from January 2013 to December 2017 were consecutively enrolled.NLR,which was defined as neutrophil counts divided by lymphocyte counts,was measured 1 day within admission and 3 days before discharge to evaluate the prognostic value of admission NLR in combination with discharge NLR for the ACD after discharge by using of multivariate Cox regression analysis.Patients were followed-up until December 2020 or ACD.Results A total of 368 patients hospitalized with HFrEF were enrolled with an age of(54±14)years,including 79 females(21.5%).During the median(inter-quartile range,IQR)duration of follow-up after discharge of 30(10,60)months,95 patients died,thus,the rate of ACD was 25.8%.Multivariate Cox regression analysis showed that the NLR level before discharge was an independent predictor of ACD after discharge[hazard ratio(HR)=1.143,95%confidence interval(CI)1.048-1.248,P=0.003]after adjusting for other parameters such as systolic blood pressure on admission and at discharge,left ventricular end-diastolic diameter on admission,and usage of aldosterone receptor blockers at discharge.Moreover,compared to those with NLR level at admission≤2.25 and≤2.00 before discharge,the long-term risk of ACD after discharge was nearly doubled for patients with NLR level at admission>2.25 and>2.00 before discharge(adjusted HR=1.968,95%CI 1.198-3.234,P=0.008).Conclusions The NLR level before discharge was an independent predictor of ACD after discharge for patients hospitalized with HFrEF.Combining NLR levels at admission and before discharge help to better predictive the risk of long-term ACD after discharge.