入院时中性粒细胞/淋巴细胞比值预测急性缺血性卒中患者院内死亡风险

Neutrophil to lymphocyte ratio at admission predicts in-hospital mortality risk in patients with acute ischemic stroke

目的探讨入院时中性粒细胞/淋巴细胞比值(neutrophil-lymphocyte ratio, NLR)对急性缺血性卒中(Acute Ischemic Stroke, AIS)患者住院期间死亡风险的预测价值。方法回顾性纳入2017年1月至2018年12月在中国医科大学附属第一医院神经内科住院的AIS患者。收集人口统计学数据和各项基线临床资料,对院内死亡组与生存组进行比较。应用多变量logistic回归分析确定AIS患者院内死亡的独立影响因素。采用受试者工作特征(receiver operating characteristic, ROC)曲线评价NLR对患者住院期间死亡的预测价值。结果共纳入AIS患者266例,平均年龄65岁,男性168例(63.2%),女性98例(36.8%);院内死亡52例(19.5%),生存214例(80.5%)。死亡组NLR显著高于生存组[中位数(四分位数间距):7.6(4.6~14.0)对2.4(1.8~4.0);Z=7.727,P<0.001]。多变量logistic分析显示,高龄[优势比(odds ratio, OR)1.07,95%可信区间(confidence interval, CI)1.01~1.14;P=0.009]、既往卒中或短暂性脑缺血发作史(OR 9.06,95% CI 2.06~39.88;P=0.004)、高NIHSS评分(OR 1. 13,95% CI 1.04~1.24;P=0.004)、高NLR(OR 1.23,95% CI 1.02~1.48;P=0.024)是AIS患者住院期间死亡的独立危险因素。ROC曲线分析显示,NLR预测AIS患者住院期间死亡的曲线下面积为0.846(95% CI 0.786~0.905;P<0.001)。当NLR的截断值为4.52时,敏感性和特异性分别为76.9%和80.8%,阳性预测值为49.4%,阴性预测值为93.5%。结论入院时NLR水平增高对AIS患者住院期间死亡具有一定的预测价值。

Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) at admission for mortality risk during hospitalization in patients with acute ischemic stroke (AIS). Methods Patients with AIS admitted to the Department of Neurology, the First Affiliated Hospital of China Medical University from January 2017 to December 2018 were enrolled retrospectively. The demographic data and all baseline clinical data were collected, and compared between the in-hospital death group and survival group. Multivariate logistic regression analysis was used to determine independent influencing factors for in-hospital death in patients with AIS. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of NLR for death during hospitalization. Results A total of 266 patients with AIS were enrolled, with an average age of 65 years, 168 were males (63.2%), 98 were females (36.8%), 52 died in hospital (19.5%), and 214 (80.5%) survived. The NLR of the death group was significantly higher than that of the survival group (median [interquartile range]: 7.6 [4.6-14.0] vs. 2.4 [1.8-4.0];Z=7.727, P<0.001). Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.14;P=0.009), previous history of stroke or transient ischemic attack (OR 9.06, 95% CI 2.06-39.88;P=0.004), high NIHSS score (OR 1.13, 95% CI 1.04-1.24;P=0.004), and high NLR (OR 1.23, 95% CI 1.02-1.48;P=0.024) were the independent risk factors for death during hospitalization in patients with AIS. ROC curve analysis showed that the area under the curve of NLR predicting death during hospitalization for patients with AIS was 0.846 (95% CI 0.786-0.905;P<0.001). When the cut-off value of NLR was 4.52, the sensitivity and specificity were 76.9% and 80.8% respectively. The positive predictive value was 49.4%, and the negative predictive value was 93.5%. Conclusions The increased NLR level at admission had certain predictive value for the death of patients with AIS during hospitalization.