基于MIMIC-Ⅲ数据库分析中性粒细胞与淋巴细胞比值对重症监护病房心力衰竭患者的预后意义  

Prognostic significance of neutrophil-to-lymphocyte ratio in intensive care heart failure patients based on MIMIC-Ⅲ database

作　　者：陈泽锋 税星[1] 郑冰涵 罗碧才[1] 陈璘[1] CHEN Ze-feng;SHUI Xing;ZHENG Bing-han;LUO Bi-cai;CHEN Lin(Department of Cardiovascular Medicine,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,Guangdong,China)

机构地区：[1]中山大学附属第三医院心血管内科,广东广州510630

出　　处：《广东医学》2022年第6期766-771,共6页Guangdong Medical Journal

摘　　要：目的中性粒细胞与淋巴细胞比值(NLR)与重症监护病房中的心力衰竭患者的预后关系尚不明确。本研究探讨NLR与入住重症监护病房的心力衰竭患者30 d死亡率的关系,为NLR用于该人群危险分层提供依据。方法从公共数据库MIMIC-Ⅲ数据库(包含了超过5万例入住重症监护室患者的临床资料)提取临床资料。共入组3113例入住监护病房的心力衰竭患者。所有的患者依据NLR水平均分为3组(NLR<6.7,NLR 6.7~13.6,NLR>13.6)。主要终点是30 d死亡率。先后使用Kaplan-Meier法及Cox风险比例回归模型研究NLR与30 d死亡率的关系,通过多因素分析校正混杂因素。结果3113例重症监护病房心力衰竭患者中30 d死亡的患者共有725例,30 d死亡发生率为23.3%。经过构建无事件生存曲线并使用Log-rank检验比较3组患者的生存曲线后发现第二组(NLR 6.7~13.6)和第三组(NLR>13.6)的患者30 d死亡发生率较第一组(NLR<6.7)的患者高。使用Cox风险比例回归模型进行多因素校正后,作为定量变量,NLR升高是重症监护病房心力衰竭患者30 d死亡发生的危险因素(HR=1.118,95%CI:1.016~1.211,P=0.016)。作为分类变量,NLR水平也与重症监护病房心力衰竭患者30 d死亡发生正相关,与第一组(NLR<6.7)相比,第二组(NLR 6.7~13.6)和第三组(NLR>13.6)的HR值(95%CI)分别为1.554(1.150,2.101)(P=0.004)和1.578(1.175,2.118)(P=0.002)。结论NLR升高是重症监护病房心力衰竭患者30 d死亡的独立危险因素。Objective To investigated the association between the neutrophil-to-lymphocyte ratio(NLR)and 30-day mortality of intensive care heart failure patients.Methods Clinical date were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III(MIMIC-Ⅲ)database,which contained more than 50,000 intensive care patients;and 3113 intensive care heart failure patients were enrolled.All patients were divided into 3 groups according to NLR levels(NLR<6.7,NLR 6.7-13.6,and NLR>13.6).The primary outcome was 30-day mortality.Kaplan-Meier and Cox proportional hazard models were used to investigate the correlation between NLR and 30-day mortality.Multivariate survival analysis was used to control confounders.Results A total of 725 patients suffered from mortality,and the incidence of 30-day mortality was 23.3%.After constructing the event-free survival curves and comparing the survival rate by Log-rank test,it was found that patients with NLR 6.7-13.6 and patients with NLR>13.6 had higher incidences of 30-day mortality.As a quantitative variable,NLR level was a risk factor of 30-day mortality in intensive care heart failure patients(HR=1.118,95%CI:1.016-1.211,P=0.016).As a categorical variable,NLR>6.7 was also positively correlated with 30-day mortality in intensive care heart failure patients.Conclusion Elevated NLR is an independent predictor of 30-day mortality for intensive care heart failure patients.

关 键 词：中性粒细胞与淋巴细胞比值 心力衰竭 30天死亡率 MIMIC-Ⅲ数据库 

分 类 号：R446.11[医药卫生—诊断学]