新型免疫/炎症指数对扩张型心肌病患者非计划入住ICU的影响

Effects of novel immune/inflammatory indices on unplanned ICU admission in patients with dilated cardiomyopathy

目的:本研究旨在评价新型免疫/炎症指数[血小板-淋巴细胞比(PLR)、中性粒细胞-淋巴细胞比(NLR)、单核细胞-淋巴细胞比(MLR)、全身免疫炎症指数(SII)以及全身炎症反应指数(SIRI)]对扩张型心肌病(DCM)住院患者非计划入住ICU的预测价值。方法:选取2017年—2020年就诊新疆医科大学第一附属医院心脏中心的973例DCM住院患者,收集临床资料及检查检验数据,根据是否发生非计划入住ICU分组。采用logistic回归和限制型立方样条(RCS)曲线分析评估新型免疫/炎症指数与非计划入住ICU的关系。利用净重新分类指数(NRI)和综合判别指数(IDI)评估新型免疫/炎症指数对GWTG-HF评分的改善能力。结果:共有103例(10.59%)DCM住院患者发生非计划入住ICU。多元logistic回归分析提示PLR(OR:1.01,95%CI:1.01~1.01,P<0.001)、NLR(OR:1.28,95%CI:1.19~1.39,P<0.001)、SIRI(OR:1.19,95%CI:1.09~1.29,P<0.001)和SII(OR:1.00,95%CI:1.00~1.00,P<0.001)是非计划入住ICU的独立预测因素。RCS曲线分析提示新型免疫/炎症指数与非计划入住ICU风险整体表现为上升趋势(P<0.05)。将PLR、NLR、SIRI以及SII分别添加到GWTG-HF评分中,明显改善了其预测能力(P<0.05),而且NRI和IDI水平也都有一定的提升(P<0.05)。结论:新型免疫/炎症指数与DCM住院患者发生非计划入住ICU风险独立相关。GWTG-HF评分与新型免疫/炎症指数结合可以更准确地预测非计划入住ICU风险。

Objective To evaluate the predictive value of novel immune/inflammatory indices[platelet-lymphocyte ratio(PLR),neutrophils-lymphocytes ratio(NLR),monocytes-lymphocytes ratio(MLR),systemic immune inflammatory index(SII),and systemic inflammatory response index(SIRI)]for unplanned ICU admission in dilated cardiomyopathy(DCM)inpatients.Methods A total of 973 DCM inpatients from the First Affiliated Hospital of Xinjiang Medical University from 2017 to 2020 were retrospectively analyzed.Clinical and inspection data were collected,and they were grouped according to whether unplanned ICU admission occurred.Logistic regression and restricted cubic spline(RCS)profiling were used to assess the relationship between novel immune/inflammatory indices and unplanned ICU admission.The ability of novel immune/inflammatory indices to improve GWTG-HF scores was assessed using the net reclassification index(NRI)and the integrated discrimination index(IDI).Results A total of 103(10.59%)DCM inpatients had unplanned admission to ICU.Multivariate logistic regression analysis revealed independent predictive factors for PLR(OR:1.01,95%CI:1.01-1.01,P<0.001),NLR(OR:1.28,95%CI:1.19-1.39,P<0.001),SIRI(OR:1.19,95%CI:1.09-1.29,P<0.001)and SII(OR:1.00,95%CI:1.00-1.00,P<0.001)for unplanned ICU admission.The RCS curve indicated an overall upward trend in the risk of novel immune/inflammatory indices and unplanned ICU admission(P<0.05).Adding PLR,NLR,SIRI,and SII to the GWTG-HF score significantly improved predictive ability(P<0.05),as did NRI and IDI levels(P<0.05).Conclusion Novel immune/inflammatory indices were significantly and independently associated with unplanned ICU admission in DCM inpatients.And the combination of novel immune/inflammatory indices with GWTG-HF score could predict unplanned ICU admission more accurately.