中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值对急性心肌梗死患者住院死亡风险的联合预测价值

Combined Predictive Value of Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio for In-hospital Mortality Risk in Patients with Acute Myocardial Infarction

背景已有研究表明中性粒细胞/淋巴细胞比值(NLR)与血小板/淋巴细胞比值(PLR)对心血管疾病具有较好的预测价值,少有研究探讨NLR联合PLR能否增强对急性心肌梗死(AMI)患者住院期间死亡风险的预测价值。目的探讨NLR联合PLR对AMI患者短期预后的预测价值。方法2015年12月—2021年12月纳入在大连医科大学附属第二医院心血管内科住院的3246例AMI患者的病例资料,最终结局为住院期间全因死亡,根据最终结局将患者分为院内死亡组和非死亡组,采用倾向性得分匹配(PSM)按1∶1匹配。绘制NLR+PLR、NLR和PLR对AMI患者住院死亡风险预测价值的受试者工作特征曲线(ROC曲线)。为了更好地评估NLR+PLR对不同类型AMI患者院内死亡风险的预测价值,将患者分为非ST段抬高型心肌梗死(NSTEMI)组和ST段抬高型心肌梗死(STEMI)组,并分析NLR+PLR、NLR和PLR对NSTEMI组和STEMI组患者住院死亡风险的预测价值。结果(1)基于PSM按照1∶1的比例对住院期间死亡患者进行匹配,每组115例。两组匹配后匹配变量比较,差异无统计学意义(P>0.05)。(2)NLR+PLR预测AMI患者住院死亡风险的ROC曲线下面积(AUC=0.754)大于NLR(AUC=0.731)和PLR(AUC=0.577)(P<0.05)。(3)NLR+PLR对STEMI患者住院死亡风险的预测能力(AUC=0.797)高于NSTEMI患者(AUC=0.739)。结论与单独的NLR或PLR相比,NLR联合PLR可以更好地预测AMI患者住院期间的死亡风险,尤其是在STEMI患者中效能更佳。

Background Neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)have been shown to have significant predictive value for cardiovascular disease in previous studies,however,whether the combination of NLR and PLR can enhance the predictive value for in-hospital mortality risk in patients with acute myocardial infarction(AMI)has not been investigated.Objective To investigate the combined predictive value of NLR and PLR in the short-term prognosis of AMI patients.Methods The case data of 3246 AMI patients hospitalized in the Department of Cardiology of the Second Hospital of Dalian Medical University from December 2015 to December 2021 were included,with the final outcome of all-cause death during hospitalization,who were divided into in-hospital death and non-death groupsand matched 1∶1 using propensity score matching(PSM).Receiver operating characteristic(ROC)curves were plotted for the predictive value of NLR+PLR,NLR,and PLR for the risk of in-hospital death in AMI patients.In order to better evaluate the predictive value of NLR+PLR for in-hospital mortality risk in patients with different types of AMI,patients were divided into NSTEMI and STEMI groups,and the predictive values of NLR+PLR,NLR,and PLR for in-hospital mortality risk in patients with NSTEMI and STEMI groups were analyzed.Results(1)Patients who died during hospitalization were matched based on PSM in a 1∶1 ratio,with 115 patients in each group.There was no significantly different in matching variables between the two groups after matching(P>0.05).(2)The area under the ROC curve of NLR+PLR for predicting the risk of in-hospital mortality in AMI patients(AUC=0.754)was greater than NLR(AUC=0.731)and PLR(AUC=0.577)(P<0.05).(3)NLR+PLR had a higher predictive ability for in-hospital mortality risk in STEMI patients(AUC=0.797)than in NSTEMI patients(AUC=0.739).Conclusion Compared with NLR or PLR alone,the combination of NLR and PLR can better predict the risk of in-hospital mortality in AMI patients,especially with better efficacy in STEMI patients.