Palyatif hastalarda nötrofil-lenfosit oranı ve sağ kalım: ölüm gününü tahmin edebilir miyiz?

Abstract

Amaç: Bu çalışma, enfeksiyon bulgusu olmayan palyatif bakım hastalarında nötrofil/lenfosit oranının (NLR) kısa dönem (30 gün) ve uzun dönem (1 yıl) mortaliteyle ilişkisini değerlendirmeyi; NLR ile ölüm zamanı arasındaki korelasyonu incelemeyi ve NLR’nin yaş, fonksiyonel durum ve beslenme riskinden bağımsız olarak kısa dönem mortaliteyi öngörüp öngörmediğini belirlemeyi amaçlamıştır. Gereç ve Yöntem: 1 Ocak 2019 – 1 Ocak 2021 tarihleri arasında yatırılan hastaların tıbbi kayıtları retrospektif olarak incelendi. Klinik veya laboratuvar olarak enfeksiyon bulgusu olan ya da immünosüpresif tedavi alan hastalar dışlanarak toplam 335 hasta dahil edildi. Demografik veriler, tanılar, laboratuvar parametreleri, ECOG performans skorları ve NRS-2002 kaydedildi. NLR, yatışta alınan kan örneklerinden hesaplandı. Grup karşılaştırmalarında Mann–Whitney U, korelasyon analizlerinde Spearman kullanıldı; 30 günlük mortaliteyi öngören bağımsız değişkenler, yaş, NLR, ECOG ve NRS-2002’yi içeren çok değişkenli lojistik regresyon modeliyle değerlendirildi. ROC analizi ile AUC ve optimal kesim değeri hesaplandı. Bulgular: Ortalama yaş 72,3 ± 15,2 yıl olup hastaların %54,9’u erkekti; %40,8’inde malignite mevcuttu. İlk 30 gün içinde eksitus olanlarda NLR belirgin derecede yüksekti (median 9,33 vs. 4,00; p=0,001). Benzer şekilde 1 yıllık mortalitede de NLR yüksek saptandı (median 6,78 vs. 4,01; p=0,001). İlk 30 gün içinde ölenlerde NLR ile ölüm günü arasında pozitif korelasyon izlendi (ρ=0,316; p=0,0016). Çok değişkenli analizde NLR, 30 günlük mortalitenin bağımsız belirleyicisi olarak bulundu (OR=1,18; %95 GA: 1,12–1,25; p<0,001). ROC analizinde ise NLR’nin ayırt edici performansı kabul edilebilir düzeydeydi (AUC=0,731; cut-off ≥9,05). Sonuç: NLR, yaş, fonksiyonel durum ve beslenme riskinden bağımsız olarak mortalite ve ölüm zamanıyla ilişkili basit ve maliyeti düşük bir biyomarker olup, palyatif bakımda klinik karar verme süreçlerine katkı sağlayabilir.

Keywords

• alyatif bakım
• nötrofil-lenfosit oranı
• mortalite
• ölüm zamanı
• prognoz

Neutrophil/lymphocyte ratio and survival in palliative patients: can we predict the day of death?

Abstract

Aims: This study aimed to evaluate the relationship between neutrophil-to-lymphocyte ratio (NLR) and short-term (30-day) and long-term (1-year) mortality in palliative inpatients without evidence of infection; to assess the correlation between NLR and time to death; and to determine whether NLR predicts short-term mortality independent of age, functional status, and nutritional risk. Methods: Medical records of patients admitted between January 1, 2019 and January 1, 2021 were retrospectively analyzed. Patients with clinical or laboratory evidence of infection or receiving immunosuppressive therapy were excluded, yielding 335 patients. Demographics, diagnoses, laboratory values, ECOG scores, and NRS-2002 were recorded. NLR was calculated from admission blood counts. Group comparisons used Mann–Whitney U, correlations used Spearman, and predictors of 30-day mortality were tested with multivariate logistic regression including age, NLR, ECOG, and NRS-2002; ROC analysis provided AUC and optimal cut-off. Results: Mean age was 72.3±15.2 years; 54.9% were male; 40.8% had malignancy. NLR was higher in those dying within 30 days (median 9.33 vs. 4.00; p=0.001) and 1-year (median 6.78 vs. 4.01; p=0.001), and correlated with day of death at 30 days (ρ=0.316; p=0.0016). Multivariate analysis identified NLR as an independent predictor of 30-day mortality (OR=1.18; 95% CI: 1.12–1.25; p<0.001), and ROC analysis demonstrated acceptable discriminative performance (AUC=0.731; cut-off ≥9.05). Conclusion: NLR is a simple and inexpensive biomarker associated with mortality and death timing independent of age, functional status, and nutritional risk, and may assist clinical decision-making in palliative care.

Keywords

• Palliative care
• neutrophil-to-lymphocyte ratio
• mortality
• time of death
• prognosis

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