中性粒细胞淋巴细胞比值对急性呼吸窘迫综合征患者预后价值的研究

Prognostic value of neutrophil-lymphocyte ratio in patients with acute respiratory distress syndrome

目的探索中性粒细胞淋巴细胞比值(NLR)在急性呼吸窘迫综合征(ARDS)中的预后作用。方法选取2016年1月至2018年10月期间就诊于苏州市相城区第二人民医院和苏州市立医院东区的ARDS患者并获取其临床信息。采用相关性分析和多因素回归分析、生存分析探索NLR与患者预后关系。结果共计纳入80例ARDS患者,NLR中位值为14。死亡患者年龄、有创机械通气比例、NLR和肌酐显著高于存活患者,而氧合指数和血浆白蛋白低于存活患者。NLR无论作为连续性变量(HR=1.011,95%CI:1.004~1.017,P=0.001),还是以14为界限的二分类变量(HR=1.532,95%CI:1.095~2.143,P=0.013),均是ARDS独立预后因子。NLR>14的ARDS患者的住院死亡率、28 d死亡率、90 d死亡率和有创机械通气比例均显著高于NLR≤14患者。结论ARDS确诊早期(24 h)NLR>14是其独立不良预后因子。

Objective To explore the prognostic value of neutrophil-to-lymphocyte ratio(NLR)in acute respiratory distress syndrome(ARDS).Methods ARDS patients visiting the Second People′s Hospital of Suzhou Xiangcheng and Eastern District of Suzhou Municipal Hospital from January 2016 to October 2018 were enrolled and clinical information were recorded.Correlation analysis,multivariate regression analysis,and survival analysis were used to explore the prognostic value of NLR.Results A total of 80 ARDS patients were included and the median value of NLR was 14.The age,proportion of invasive mechanical ventilation,NLR,and creatinine in non-surviving patients were significantly higher than those in surviving patients,while oxygenation index and plasma albumin in non-surviving patients were significantly lower than those in surviving patients.NLR was significantly associated with overall survival(HR=1.011,95%CI:1.004-1.017,P=0.001).In the multivariate Cox regression model,it was further identified that NLR>14 as an independent prognostic factor for overall survival(HR=1.532,95%CI:1.095-2.143,P=0.0013).Hospitalized mortality,28-day mortality,90-day mortality,and proportion of invasive mechanical ventilation in ARDS patients with NLR>14 were significantly higher than those with NLR≤14.Conclusions NLR>14 is an independent poor prognostic factor in the early diagnosis of ARDS(24 hours).