中性粒细胞百分比与白蛋白比值对急性心力衰竭合并心包积液患者预后影响分析

Prognostic value of neutrophil percentage-to-albumin in patients with acute heart failure and pericardial effusion

目的:探讨中性粒细胞百分比与白蛋白比值(NPAR)对急性心力衰竭(AHF)合并心包积液(PE)患者住院死亡的预测价值。方法:回顾性纳入2015年1月至2019年12月,在北京安贞医院住院的同时患有AHF和PE的患者,收集其临床资料。计算NPAR并根据NPAR的四分位数将患者分为四组:组1(0.88≤NPAR≤1.59)、组2(1.60≤NPAR≤1.84),组3(1.85≤NPAR≤2.21),组4(2.22≤NPAR≤4.33)。主要终点为住院期间的全因死亡。比较组间基线资料及住院死亡的差异。采用二元Logistic回归探索NPAR是否为住院死亡的独立影响因素并绘制受试者工作特征(ROC)曲线评估NPAR对住院死亡的预测价值。结果:研究共纳入患者192例,32例(17.9%)患者出现住院死亡。高NPAR组肺炎、急性肾损伤发病率升高且更多接受钙离子通道阻滞剂药物治疗(P均<0.05)。高NPAR组住院死亡明显升高(P<0.001)。单因素Logistics回归分析的结果(模型1)显示NPAR与住院死亡风险升高密切相关(组4vs.组1:OR=32.571,95%CI:4.134~256.627,P=0.001)。调整了年龄、性别、BMI的模型2显示两者仍密切相关(组4vs.组1:OR=29.239,95%CI:3.527~242.396,P=0.002)调整了更多混杂变量后(模型3),结果表明NPAR与住院死亡风险升高相关(组4vs.组1:OR=18.437,95%CI:1.474~230.604,P=0.024)。当将NPAR作为连续变量纳入回归方程时,NPAR每升高1个单位,住院死亡风险分别升高3.560倍(模型1)、3.252倍(模型2)和2.151倍(模型3)。ROC分析的结果显示,NPAR具有良好的预测住院死亡的能力(AUC=0.760,95%CI:0.679~0.841,P<0.001),对应的最佳截断值为2.045,敏感度为69.4%,特异度为74.4%。NPAR是AHF合并PE患者住院死亡的独立影响因素,并可预测住院死亡的发生。

Objective:To investigate the prognostic value of neutrophil percentage-to-albumin(NPAR)on in-hospital death in patients with acute heart failure(AHF)and pericardial effusion(PE).Methods:This retrospective study included patients with AHF and PE hospitalized in Beijing Anzhen Hospital from January 2015 to December 2019,and the clinical data were collected.NPAR was calculated and patients were divided into four groups according to the quartile of NPAR:group 1(0.88≤NPAR≤1.59),group 2(1.60≤NPAR≤1.84),group 3(1.85≤NPAR≤2.21),and group 4(2.22 NPAR≤4.33).The primary end point was allcause death during hospitalization.The differences of baseline data and in-hospital death between groups were compared.The binary logistic regression was used to explore whether NPAR was an independent risk factor of in-hospital death,and the ROC curve was used to evaluate the prognostic value of NPAR for inhospital death.Results:Totally 192 patients were included in the study,and 32 patients(17.9%)deaths occurred during hospitalization.In the high NPAR group,patients had more pneumonia and acute kidney injury increased and more received calcium channel blockers(P<0.05).In the high NPAR group,the inhospital death was significantly increased(P<0.001).The results of unadjusted logistic regression analysis(model 1)showed that NPAR was closely related to the increased risk of in-hospital death(group 4 vs.group 1:OR=32.571,95%CI:4.134-256.627,P=0.001).Model 2 adjusted for age,sex and body mass index showed similar results(group 4 vs.group 1:OR=29.239,95%CI:3.527-242.396,P=0.002).After adjusting for more confounding variables(model 3),the results showed that NPAR was an independent risk factor of in-hospital death(group 4 vs.group 1:OR=18.437,95%CI:1.474-230.604,P=0.024).When NPAR was included in the regression equation as a continuous variable,the risk of in-hospital death increased 3.560 times(model 1),3.252 times(model 2)and 2.151 times(model 3)for every unit of increase in NPAR.The results of ROC analysis indicated that NPAR had a good ability to predict in-hospital death(AUC=0.760,95%CI:0.679–0.841,P<0.001).The cutoff value was 2.045,sensitivity was 69.4%,and specificity was 74.4%.Conclusions:NPAR is an independent risk factor of in-hospital death in AHF patients with PE,and can predict the occurrence of inhospital death.