中性粒细胞与淋巴细胞比值和嗜酸性粒细胞对AECOPD患者出院后1年内COPD相关再入院的预测价值

Predictive value of neutrophil-to-lymphocyte ratio and eosinophil on COPD related readmission within 1 year after discharge in patients with AECOPD

目的探究中性粒细胞/淋巴细胞比率(NLR)和嗜酸性粒细胞计数(EOS)对慢性阻塞性肺疾病急性加重期(AECOPD)患者出院后1年内慢性阻塞性肺疾病(COPD)相关再入院的预测价值。方法将2020年12月至2022年6月阜阳市第二人民医院收治的100例AECOPD患者纳入本次回顾性研究,将出院后1年内有≥1次再入院记录的患者纳入再入院组(n=35),其他患者纳入非再入院组(n=65)。比较两组的临床资料(包括一般资料、实验室检查资料、治疗方法和死亡情况)。根据NLR、EOS的预测AECOPD再入院的受试者工作特征(ROC)曲线截断值将患者分组,分别为高NLR组(n=43)和低NLR组(n=57)、低EOS组(n=51)和高EOS组(n=49)。比较各组的住院时间、1年内COPD相关再入院情况和死亡情况,采用Logistic回归分析NLR、EOS预测AECOPD再入院的风险。结果再入院组患者住院时间为(16.68±6.44)d,明显长于非再入院组[(14.02±6.26)d],全身糖皮质激素使用患者比率为28.57%,明显少于非再入院组(53.85%),NLR为8.57±3.16,显著低于非再入院组(13.97±3.79),EOS为(0.25±0.07)×10^(9)/L,显著高于非再入院组[(0.12±0.06)×10^(9)/L],差异均有统计学意义(P<0.05)。低NLR组1年内COPD相关再入院次数和人数占比分别为(1.32±0.34)次、46.51%,均高于高NLR组[(0.83±0.31)次、26.32%],差异均有统计学意义(P<0.05)。高EOS组1年内COPD相关再入院次数和人数占比分别为(1.35±0.40)次、44.90%,均高于低EOS组[(0.81±0.37)次、25.49%],差异均有统计学意义(P<0.05)。Logistic回归分析显示,低NLR(<4.85)与高EOS(≥0.1×10^(9)/L)与1年内COPD相关的再入院风险相关[OR=4.394(95%CI:1.152~8.203);OR=4.699(95%CI:1.152~8.583)]。结论入院时的NLR和EOS可能与AECOPD患者出院后1年内COPD相关再入院有关,可作为预测出院后再住院的生物标志物。

Objective To investigate the predictive value of neutrophil-lymphocyte ratio(NLR)and eosinophil count(EOS)on chronic obstructive pulmonary disease(COPD)related readmission within 1 year after discharge in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 100 AECOPD patients admitted to the Second People's Hospital of Fuyang City from December 2020 to June 2022 were included in this retrospective study.Patients with one or more readmission record within one year after discharge were included in the readmission group(n=35),and other patients were included in the non-readmission group(n=65).Clinical data(including general information,laboratory test data,treatment methods,and mortality status)of the two groups were compared.Patients were divided into the high NLR group(n=43)and the low NLR group(n=57),the low EOS group(n=51),and the high EOS group(n=49)according to the cut-off values of receiver operating characteristic(ROC)curves for predicting readmission of AECOPD using NLR and EOS.The hospital stay,COPD related readmission within 1 year and mortality were compared.Logistic regression analysis was conducted to assess the risk of readmission for AECOPD using NLR and EOS as predictors.Results The hospital stay of patients in the readmission group was(16.68±6.44)days,which was significantly longer than that in the non readmission group[(14.02±6.26)days],the proportion of patients receiving systemic glucocorticoids was 28.57%,which was significantly lower than that in the non readmission group(53.85%),the NLR was 8.57±3.16,which was significantly lower than that in the non readmission group(13.97±3.79),and the EOS was(0.25±0.07)×10^(9)/L,which was significantly higher than that in the non readmission group[(0.12±0.06)×10^(9)/L],the differences were statistically significant(P<0.05).The frequency and proportion of COPD related readmissions within 1 year in the low NLR group were(1.32±0.34)and 46.51%,respectively,which were higher than those in the high NLR group[(0.83±0.31)and 26.32%],the differences were statistically significant(P<0.05).The number and proportion of COPD related readmission within 1 year in the high EOS group were(1.35±0.40)and 44.90%,respectively,which were higher than those in the low EOS group[(0.81±0.37)and 25.49%],the differences were statistically significant(P<0.05).Logistic regression analysis showed that low NLR(<4.85)and high EOS(≥0.1×10^(9)/L)was associated with the risk of readmission related to COPD within 1 year[OR=4.394(95%CI:1.152-8.203);OR=4.699(95%CI:1.152-8.583)].Conclusion NLR and EOS at admission may be related to COPD related readmission within 1 year after discharge,and can be considered as biomarkers for predicting readmission rates after discharge.