中性粒细胞淋巴细胞比值对扩张型心肌病患者短期死亡风险的预测价值

The predictive value of neutrophil to lymphocyte ratio for risk of short-term death in patients with dilated cardiomyopathy

目的:探讨中性粒细胞淋巴细胞比值(NLR)是否为扩张型心肌病(DCM)患者短期死亡风险的危险因素及其预测价值。方法:回顾性分析了2012年10月至2020年5月纳入的DCM患者队列,根据三分位数从小到大将NLR从连续变量转换为分类变量(T1、T2、T3)进行分析;应用单变量和多变量logistic回归模型来评估NLR与短期死亡风险之间的关系;并通过受试者工作特征(ROC)曲线评估NLR的预测价值。结果:666例DCM患者被纳入最终分析,短期死亡率为6.91%。多变量分析表明,NLR每增加一个单位,短期死亡风险就会增加17.1%(OR=1.171,95%CI:1.083~1.265);与T1相比,T3的死亡风险增加1.62倍(OR=2.622,95%CI:1.039~6.616)。ROC曲线分析显示,NLR的曲线下面积为0.720(95%CI:0.637~0.802),最佳截断值为3.970,敏感度和特异度分别为60.9%、76.9%;曲线间比较显示其预测价值优于心衰分级及左室射血分数(P<0.05)。结论:NLR是DCM患者短期死亡风险的危险因素,对NLR的评估可能有助于识别DCM高风险个体。

Objective:To investigate whether the neutrophil to lymphocyte ratio(NLR) is a critical risk factor for short-term mortality in patients with dilated cardiomyopathy(DCM) and its predictive value.Methods:Clinical data of DCM patients enrolled between October 2012 and May 2020 was retrospectively analyzed.According to the tri-sectional quantiles from small to large,NLR was converted from continuous variables to categorical variables(T1,T2,T3) for analysis.Univariate and multivariate logistic regression models were used to assess the association between NLR and the risk of short-term death.The predictive value of NLR was evaluated by the receiver operating characteristic(ROC) curve.Results:A total of 666 patients with DCM were included in the final analysis,and the short-term mortality was 6.91%.Multivariate analysis showed that for each unit increase in NLR,the risk of short-term death increased by 17.1%(OR=1.171,95% CI:1.083-1.265);compared with T1,T3 was associated with a 1.62-fold(OR=2.622,95% CI:1.039-6.616) increased risk of death.ROC curve analysis showed that the area under the curve of NLR was 0.720(95% CI:0.637-0.802),the optimal cut-off value was3.970,and the sensitivity and specificity were 60.9% and 76.9%,respectively.Comparison between curves showed that its predictive value was better than heart failure classification and left ventricular ejection fraction(P<0.05).Conclusion:NLR is a critical risk factor for short-term death in DCM patients.NLR assessment may help identify high-risk individuals.