单核细胞与淋巴细胞比值对重症患者病死率的预测意义

The predictive value of monocyte-lymphocyte ratio for mortality in intensive care unit patients:a cohort study

目的探讨单核细胞与淋巴细胞比值(monocyte-lymphocyte ratio,MLR)和重症监护病房(intensive care unit,ICU)住院患者病死率之间的联系。方法从重症监护多参数智能监测Ⅲ数据库中提取临床数据,该数据库包含超过50000例住院患者的健康数据。主要结局指标是30天病死率,次要结局指标是90天病死率。使用Cox比例风险模型分析MLR与ICU住院患者的全因病死率之间的关联,应用多变量分析控制相关混杂因素,并用局部加权回归散点平滑法查看二者之间的关系。结果研究共纳入7295例ICU住院患者。在主要结局指标30天病死率中,与MLR<0.23组相比,0.23≤MLR<0.47组患者的风险比与95%可信区间为1.28(1.01,1.61),MLR≥0.47组患者的风险比及95%可信区间为2.70(2.20,3.31)。通过在两种不同的模型进行校正后,风险比仍显著。由模型1校正后,0.23≤MLR<0.47组和MLR≥0.47组患者的风险比与95%可信区间分别为1.16(0.92,1.47)和2.27(1.85,2.78)。模型2校正后,0.23≤MLR<0.47组和MLR≥0.47组患者的风险比与95%可信区间分别为1.13(0.89,1.42)和2.05(1.67,2.52)。在次要指标90天病死率中观察到了同样的趋势。在合并冠状动脉粥样硬化性心脏病和卒中的患者中,MLR≥0.47组患者的30天死亡风险显著更高,分别为3.28(1.99,5.40)和3.20(1.56,6.56)。结论MLR是有前景的临床生物标志物,对重症患者30天和90天病死率具有预测意义。

Objective To investigate the correlation between monocyte-lymphocyte ratio(MLR)and intensive care unit(ICU)results in ICU hospitalized patients.Methods Clinical data were extracted from Medical Information Mart for Intensive CareⅢdatabase,which contained health data of more than 50000 patients.The main result was30-day mortality,and the secondary result was 90-day mortality.The Cox proportional hazards model was used to reveal the association between MLR and ICU results.Multivariable analyses were used to control for confounders.Results A total of 7295 ICU patients were included.For the 30-day mortality,the hazard ratio(HR)and 95%confidence interval(CI)of the second(0.23≤MLR<0.47)and the third(MLR≥0.47)groups were 1.28(1.01,1.61)and 2.70(2.20,3.31),respectively,compared to the first group(MLR<0.23).The HR and 95%CI of the third group were still significant after being adjusted by the two different models[2.26(1.84,2.77),adjusted by model 1;2.05(1.67,2.52),adjusted by model 2].A similar trend was observed in the 90-day mortality.Patients with a history of coronary and stroke of the third group had a significant higher30-day mortality risk[HR and 95%CI were 3.28(1.99,5.40)and 3.20(1.56,6.56),respectively].Conclusion MLR is a promising clinical biomarker,which has certain predictive value for the 30-day and 90-day mortality of patients in ICU.