Akut pulmoner emboli hastalarında nötrofil-lenfosit oranındaki dinamik değişimin prognostik etkisi

Year 2020, Volume: 9 Issue: 2, 101 - 108, 31.08.2020

Adil Gökuç Tuncay Kırış Tarık Yıldırım Eyüp Avcı

Abstract

Amaç: Nötrofil / lenfosit oranındaki (NLO) zamansal değişikliklerin akut pulmoner embolide (APE) toplam mortalite ile ilişkili olup olmadığı açık değildir. APE'li hastalarda prognoz için NLO'nun dinamik izlenmesinin değerini araştırdık.
Yöntemler: 214 ardışık APE hastasını geriye dönük olarak analiz ettik. Hastalar hayatta kalanlar veya hayatta kalmayanlar olarak iki gruba ayrıldı. Nötrofil sayısı, lenfosit sayısı ve NLO, başvuru sırasında ve 72. saatte elde edildi. İki ölçüm arasındaki fark NLR değişimi (ΔNLR) olarak kabul edildi. Çalışmanın sonlanım noktası, 30 günlük takipte toplam ölüm oranıydı.
Bulgular: Takip sırasında 30 ölüm (% 14) saptandı. ΔNLR, hayatta kalmayanlarda hayatta kalanlara göre daha yüksekti (5.22 [0.62-7.76] ve -0.71 [-2.28-0.76], P <0.001). Çok değişkenli analizde, ΔNLR'nin 30 günlük mortalitenin önemli bir prediktörü olduğu bulundu (OR: 1.059,% 95 CI: 1.021-1.098, p = 0.002). 30 günlük mortalite için basitleştirilmiş pulmoner emboli ciddiyet indeksi (sPESI) skorunun eğri altındaki alan (AUC) 0,719 (% 95 CI: 0,630-0,809, p <0,001) idi. ΔNLR, sPESI skoruna eklendiğinde, AUC 0.841 (% 95 CI: 0.769-0.913, fark p = 0.0008, Şekil 1) idi. Dahası, ΔNLR'nin sPESI skoruna eklenmesi, % 68.9 (p <0.001) olarak tahmin edilen önemli bir net yeniden sınıflandırma iyileşmesi ve 0.108'lik (p = 0.0046) bir entegre ayrımcılık gelişimi ile ilişkilendirildi.
Sonuç: Bulgularımız, başvuru sonrası NLO'daki artışın APE hastalarında total mortalite ile bağımsız olarak ilişkili olduğunu göstermektedir.

Keywords

nötrofil lenfosit oranı, inflamasyon, pulmoner emboli, mortalite

The prognostic impact of dynamic change in neutrophil to lymphocyte ratio in patients with acute pulmonary embolism

Abstract

Background: It is unclear whether temporal changes in neutrophil to lymphocyte ratio (NLR) are associated with total mortality in acute pulmonary embolism (APE). We investigated the value of dynamic monitoring of NLR for the prognosis in patients with APE.
Methods: We retrospectively analyzed 214 consecutive APE patients. The patients were divided into two groups: survivors or non-survivors. The neutrophil count, lymphocyte count and NLR were obtained at admission and 72 hours. The difference between the 2 measurements was considered as the NLR change (ΔNLR). The end point of the study was total mortality at 30-day follow-up.
Results: During follow-up, there were 30 deaths (14%). ΔNLR was higher in non-survivors than survivors survivors (5.22 [0.62-7.76] vs -0.71 [-2.28-0.76], P < .001). In multivariate analysis, the ΔNLR was found to be a significant predictor of 30-day mortality (OR: 1.059, 95% CI:1.021-1.098, p=0.002). For 30-day mortality, the area under the curve(AUC) of Simplified Pulmonary Embolism Severity Index ( sPESI) score was 0.719 ( 95% CI:0.630-0.809, p < 0.001). When ΔNLR was added to sPESI score, the AUC was 0.841 (95% CI: 0.769-0.913, difference p = 0.0008, Fig.1). Morever, the addition of ΔNLR to sPESI score was associated with a significant net reclassification improvement estimated at 68.9% (p < 0.001) and an integrated discrimination improvement of 0.108 ( p = 0.0046).
Conclusion: Our findings show that an increase in NLR after admission was independently associated with total mortality in patients with APE.

Keywords

neutrophil to lymphocyte ratio, inflammation, pulmonary embolism, mortality

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