Akut Pulmoner Embolili Hastalarda Nötrofil Lenfosit Oranınıdaki Dinamik Değişimin Prognostik Etkisi

The Prognostic Impact of Dynamic Change in Neutrophil to Lymphocyte Ratio in Patients with Acute Pulmonary Embolism

Özet

Amaç: Nötrofil lenfosit oranındaki (NLR) geçici değişikliklerin akut pulmoner embolide (APE) toplam mortalite ile ilişkili olup olmadığı belirsizdir. APE'li hastalarda prognoz için NLR’nin dinamik monitorizasyonunun değerini araştırdık. Gereç ve Yöntem: 214 ardışık APE hastasını retrospektif olarak analiz ettik. Hastalar iki gruba ayrıldı: hayatta kalanlar ve ölenler. Nötrofil sayısı, lenfosit sayısı ve NLR girişte ve 72. Saatteki değerleri alındı. 2 ölçüm arasındaki fark NLR değişimi (ΔNLR) olarak kabul edildi. Çalışmanın son noktası 30 günlük takipteki toplam mortalite idi. Bulgular: Takip süresince 30 ölüm (%14) vardı. ΔNLR, hayatta kalanlarda ölenlere göre daha yüksekti (5.22 [0.62-7.76] ve -0.71 [-2.28-0.76], p

Abstract

Aim: 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.