术前中性粒细胞/淋巴细胞比值预测全身麻醉非心脏手术患者术后急性肾损伤价值

Preoperative neutrophil to lymphocyte ratio in predicting general anesthesia value without heart surgery patients with post⁃operative acute kidney injury

目的探讨术前中性粒细胞/淋巴细胞比值(NLR)对预测全身麻醉非心脏手术患者术后急性肾损伤(AKI)的价值。方法回顾性分析中南大学湘雅三医院自2012年1月至2016年12月接受全身麻醉非心脏手术的8449例患者的临床资料。根据其术前NLR的四分位数将患者分为4组,分别是Q1组(NLR<1.97,n=2112),Q2组(1.97≤NLR<3.37,n=2112),Q3组(3.37≤NLR<8.09,n=2113)和Q4组(NLR≥8.09,n=2112)。比较4组患者的基线特征,采用逻辑回归模型计算比值比及95%可信区间,采用10倍交叉验证来测试和验证模型的准确性。结果Q4组患者的血红蛋白水平低于Q1组,年龄、男性比例及糖尿病患者比例高于Q1组,差异均有统计学意义(P<0.05)。8449例全身麻醉非心脏手术患者中,335例(4.0%)在术后住院期间发生了手术相关性AKI。NLR与AKI的预测发生概率之间存在线性关系,并且在校正了多个协变量后,术前NLR与AKI之间呈线性正相关,且10倍交叉验证表明AKI的预测准确性具有统计学意义(曲线下面积=0.734,95%可信区间0.704~0.763)。结论术前NLR与术后AKI之间存在线性正相关。术前NLR作为一种简单、快速、可测量的指标,对于全身麻醉非心脏手术患者预测手术相关性的AKI具有重要意义。

Objective To investigate the value of preoperative neutrophil to lymphocyte ratio(NLR)for predicting surgery⁃related a⁃cute kidney injury(AKI)in non⁃cardiac surgery patients.Methods The clinical data of 8449 patients who underwent non⁃cardiac surgery under general anesthesia in the Third Xiangya Hospital of Central South University from January 2012 to December 2016 were retrospectively analyzed.According to the preoperative NLR quartile,the patients were divided into four groups,namely,Q1 group(NLR<1.97,n=2112),Q2 group(1.97≤NLR<3.37,n=2112),Q3 group(3.37≤NLR<8.09,n=2113)and Q4 group(NLR≥8.09,n=2112).The baseline characteristics of the four groups were compared,the odds ratio and 95%confidence interval were calculated by logistic regression model,and the accuracy of the model was tested and verified by 10⁃fold cross⁃validation.Results The hemoglobin level of Q4 group was lower than that of Q1 group,and the proportion of age,male and diabetic patients was higher than that of Q1 group,with statistical significance(P<0.05).Of the 8449 patients undergoing non⁃cardiac surgery under gen⁃eral anesthesia,335(4.0%)developed surgery⁃associated AKI during postoperative hospitalization.There was a linear relationship between NLR and the predicted probability of AKI,and after correcting for multiple covariates,there was a linear positive correlation between NLR and AKI before surgery,and 10⁃fold cross⁃validation showed that the prediction accuracy of AKI was statistically signifi⁃cant(area under the curve=0.734,95%confidence interval 0.704⁃0.763).Conclusion There is a linear positive correlation be⁃tween preoperative NLR and postoperative AKI.Preoperative NLR,as a simple,rapid and measurable indicator,is of great significance for predicting surgery⁃related AKI in non⁃cardiac surgery patients under general anesthesia.