Effects of novel immune/inflammatory indices on unplanned ICU admission in patients with dilated cardiomyopathy
-
摘要: 目的 本研究旨在评价新型免疫/炎症指数[血小板-淋巴细胞比(PLR)、中性粒细胞-淋巴细胞比(NLR)、单核细胞-淋巴细胞比(MLR)、全身免疫炎症指数(SII)以及全身炎症反应指数(SIRI)]对扩张型心肌病(DCM)住院患者非计划入住ICU的预测价值。方法 选取2017年—2020年就诊新疆医科大学第一附属医院心脏中心的973例DCM住院患者，收集临床资料及检查检验数据，根据是否发生非计划入住ICU分组。采用logistic回归和限制型立方样条(RCS)曲线分析评估新型免疫/炎症指数与非计划入住ICU的关系。利用净重新分类指数(NRI)和综合判别指数(IDI)评估新型免疫/炎症指数对GWTG-HF评分的改善能力。结果 共有103例(10.59%)DCM住院患者发生非计划入住ICU。多元logistic回归分析提示PLR(OR：1.01，95%CI：1.01~1.01，P < 0.001)、NLR(OR：1.28，95%CI：1.19~1.39，P < 0.001)、SIRI(OR：1.19，95%CI：1.09~1.29，P < 0.001)和SII(OR：1.00，95%CI：1.00~1.00，P < 0.001)是非计划入住ICU的独立预测因素。RCS曲线分析提示新型免疫/炎症指数与非计划入住ICU风险整体表现为上升趋势(P < 0.05)。将PLR、NLR、SIRI以及SII分别添加到GWTG-HF评分中，明显改善了其预测能力(P < 0.05)，而且NRI和IDI水平也都有一定的提升(P < 0.05)。结论 新型免疫/炎症指数与DCM住院患者发生非计划入住ICU风险独立相关。GWTG-HF评分与新型免疫/炎症指数结合可以更准确地预测非计划入住ICU风险。Abstract: Objective To evaluate the predictive value of novel immune/inflammatory indices[platelet-lymphocyte ratio(PLR), neutrophils-lymphocytes ratio(NLR), monocytes-lymphocytes ratio(MLR), systemic immune inflammatory index(SII), and systemic inflammatory response index(SIRI) ]for unplanned ICU admission in dilated cardiomyopathy(DCM) inpatients.Methods A total of 973 DCM inpatients from the First Affiliated Hospital of Xinjiang Medical University from 2017 to 2020 were retrospectively analyzed. Clinical and inspection data were collected, and they were grouped according to whether unplanned ICU admission occurred. Logistic regression and restricted cubic spline(RCS) profiling were used to assess the relationship between novel immune/inflammatory indices and unplanned ICU admission. The ability of novel immune/inflammatory indices to improve GWTG-HF scores was assessed using the net reclassification index(NRI) and the integrated discrimination index(IDI).Results A total of 103(10.59%) DCM inpatients had unplanned admission to ICU. Multivariate logistic regression analysis revealed independent predictive factors for PLR(OR: 1.01, 95%CI: 1.01-1.01, P < 0.001), NLR(OR: 1.28, 95%CI: 1.19-1.39, P < 0.001), SIRI(OR: 1.19, 95%CI: 1.09-1.29, P < 0.001) and SII(OR: 1.00, 95%CI: 1.00-1.00, P < 0.001) for unplanned ICU admission. The RCS curve indicated an overall upward trend in the risk of novel immune/inflammatory indices and unplanned ICU admission(P < 0.05). Adding PLR, NLR, SIRI, and SII to the GWTG-HF score significantly improved predictive ability(P < 0.05), as did NRI and IDI levels(P < 0.05).Conclusion Novel immune/inflammatory indices were significantly and independently associated with unplanned ICU admission in DCM inpatients. And the combination of novel immune/inflammatory indices with GWTG-HF score could predict unplanned ICU admission more accurately.
-
-
图 1 新型炎症/免疫指数对DCM非计划入住ICU的预测能力
Figure 1. Predictive ability of novel inflammatory/immune indices for unplanned ICU admission in DCM
图 2 新型免疫/炎症指标与非计划入住ICU风险的剂量-效应曲线
Figure 2. Dose-response curves of novel immune/inflammatory markers and risk of unplanned ICU admission
表 1 2组研究人群的基线资料
Table 1. General data
例(%), X±S 项目 ICU-(870例) ICU+(103例) t/χ2 P 年龄/岁 53.81±13.07 55.16±14.402 2.62 0.327 男性 642(73.79) 78(75.73) 0.18 0.672 吸烟 336(38.62) 35(33.98) 0.84 0.359 饮酒 190(21.84) 16(15.53) 2.19 0.139 糖尿病 133(15.29) 19(18.45) 0..69 0.404 脑梗死 34(3.91) 13(12.62) 15.21 < 0.001 慢性阻塞性肺疾病 59(6.78) 10(9.71) 1.19 0.274 血管紧张素转换酶抑制剂/血管紧张素受体Ⅱ拮抗剂 538(61.84) 58(56.31) 1.19 0.276 β受体阻滞剂 753(86.55) 83(80.58) 2.71 0.100 醛固酮受体拮抗剂 759(87.24) 83(80.58) 3.51 0.061 利尿剂 515(59.20) 55(53.40) 1.28 0.259 地高辛 255(29.31) 27(26.21) 0.43 0.512 CRT 55(6.32) 6(5.83) 0.04 0.844 ICD 43(4.94) 6(5.83) 0.15 0.698 NYHAⅣ级 166(19.08) 51(49.51) 49.23 < 0.001 体重/kg 75.41±15.84 76.738±17.13 1.35 0.424 心率/(次/min) 87.18±17.481 95.10±21.00 4.30 < 0.001 收缩压/mmHg 119.83±17.27 119.67±17.05 0.39 0.93 舒张压/mmHg 76.42±13.65 78.02±14.92 0.01 0.267 LVEDd/mm 67.53±7.92 67.88±7.85 0.17 0.672 LVEF/% 35.45±5.81 34.94±5.69 0.03 0.406 白细胞计数/(109/L) 7.08±2.19 8.40±3.35 25.49 < 0.001 红细胞计数/(1012/L) 4.79±0.66 4.70±0.78 6.08 0.17 淋巴细胞计数/(109/L) 1.89±0.71 1.47±0.69 0.01 < 0.001 单核细胞计数/(109/L) 0.58±0.38 0.68±0.33 2.78 0.015 中性粒细胞计数/(109/L) 4.44±1.88 6.12±3.22 43.58 < 0.001 血红蛋白/(g/L) 141.45±20.48 138.68±25.11 6.20 0.206 血小板计数/(109/L) 221.76±70.12 241.90±85.49 5.38 0.007 谷氨酸氨基转移酶/(U/L) 38.06±33.98 38.11±30.31 0.54 0.988 门冬氨酸氨基转移酶/(U/L) 30.58±18.25 34.39±23.59 1.62 0.053 白蛋白/(g/L) 38.75±4.85 35.40±5.33 2.45 < 0.001 肌酐/(μmol/L) 79.93±23.30 83.13±25.22 0.80 0.192 NT-ProBNP/100/(ng/mL) 38.32±38.03 57.55±50.06 14.98 < 0.001 GWTG-HF评分 44.49±6.991 47.60±7.29 1.68 < 0.001 PLR 130.54±59.29 204.08±126.72 103.74 < 0.001 NLR 2.71±1.88 5.89±6.08 171.24 < 0.001 MLR 0.36±0.64 0.58±0.47 7.45 0.001 SIRI 1.67±2.22 4.29±6.33 87.38 < 0.001 SII 602.33±504.13 1298.16±1089.12 119.66 < 0.001 注：CRT：心脏再同步化治疗；ICD：埋藏式心脏复律除颤器。 
下载: 导出CSV
表 2 新型免疫/炎症指数预测DCM非计划入住ICU风险的logistic回归分析
Table 2. logistic regression analysis
变量 单因素分析 多因素分析 β值 OR(95%CI) P值 β值 OR(95%CI) P值 PLR 0.010 1.01(1.01~1.01) < 0.001 0.009 1.01(1.01~1.01) < 0.001 NLR 0.290 1.34(1.24~1.44) < 0.001 0.249 1.28(1.19~1.39) < 0.001 MLR 0.668 1.95(0.96~3.97) 0.065 0.065 1.07(0.79~1.45) 0.673 SIRI 0.231 1.26(1.16~1.36) < 0.001 0.177 1.19(1.09~1.29) < 0.001 SII 0.001 1.00(1.00~1.00) < 0.001 0.001 1.00(1.00~1.00) < 0.001
下载: 导出CSV
表 3 新型免疫/炎症指数联合GWTG-HF评分的预测能力分析
Table 3. Analysis of the predictive ability of the new immune/inflammatory index combined with GWTG-HF score
项目 AUC(95%CI) P NRI P IDI P GWTG-HF 0.63(0.57~0.69) 参考 参考 PLR联合GWTG-HF 0.70(0.65~0.76) 0.075 0.27(0.06~0.47) 0.010 0.08(0.04~0.12) < 0.001 NLR联合GWTG-HF 0.72(0.67~0.78) 0.018 0.31(0.11~0.51) 0.003 0.11(0.06~0.15) < 0.001 SIRI联合GWTG-HF 0.72(0.66~0.77) 0.032 0.08(0.03~0.14) 0.003 0.06(0.03~0.09) < 0.001 SII联合GWTG-HF 0.74(0.69~0.80) 0.006 0.29(0.09~0.49) 0.005 0.11(0.0~0.15) < 0.001
下载: 导出CSV
-
[1] Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy[J]. Lancet, 2017, 390(10092): 400-414. doi: 10.1016/S0140-6736(16)31713-5
[2] Shiloh AL, Ari EL, Savel RH. The unplanned intensive care unit admission[J]. J Crit Care, 2015, 30(2): 419-420. doi: 10.1016/j.jcrc.2014.12.010
[3] Chioncel O, Ambrosy AP, Filipescu D, et al. Patterns of intensive care unit admissions in patients hospitalized for heart failure[J]. J Cardiovasc Med, 2015, 16(5): 331-340. doi: 10.2459/JCM.0000000000000030
[4] Jennerich AL, Hobler MR, Sharma RK, et al. Unplanned Admission to the ICU[J]. Chest, 2020, 158(4): 1482-1489. doi: 10.1016/j.chest.2020.05.554
[5] 何芳, 唐婷婷, 谢天, 等. 免疫吸附疗法应用于扩张型心肌病患者的1例病例报告并荟萃分析[J]. 临床心血管病杂志, 2022, 38(3): 233-240. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2022.03.014
[6] 廖玉华. 中国扩张型心肌病诊断和治疗指南: 创新与转化[J]. 临床心血管病杂志, 2018, 34(5): 435-436. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2018.05.002
[7] 乾叶子, 杨威, 吕媛媛, 等. N端脑钠肽前体、可溶性人基质裂解素2及血小板/淋巴细胞比值对慢性心力衰竭的诊断价值[J]. 临床心血管病杂志, 2021, 37(3): 239-243. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2021.03.011
[8] 于坚, 张爱梅, 王小红, 等. 射血分数降低型心力衰竭合并2型糖尿病患者vWF、NLR、MPVLR水平的变化及临床意义[J]. 临床心血管病杂志, 2022, 38(8): 654-658. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2022.08.011
[9] 中华医学会心血管病学分会, 中国心肌炎心肌病协作组. 中国扩张型心肌病诊断和治疗指南[J]. 临床心血管病杂志, 2018, 34(5): 421-434. doi: 10.13201/j.issn.1001-1439.2018.05.002 https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2018.05.001
[10] Peterson PN, Rumsfeld JS, Liang L, et al. A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program[J]. Circ Cardiovasc Qual Outcomes, 2010, 3(1): 25-32. doi: 10.1161/CIRCOUTCOMES.109.854877
[11] 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2021概要[J]. 中国循环杂志, 2022, 37(6): 553-578. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202306009.htm
[12] Zhao L, Fu Z. Roles of host immunity in viral myocarditis and dilated cardiomyopathy[J]. J Immunol Res, 2018, 2018: 5301548.
[13] Harding D, Chong MHA, Lahoti N, et al. Dilated cardiomyopathy and chronic cardiac inflammation: Pathogenesis, diagnosis and therapy[J]. J Int Med, 2023, 293(1): 23-47.
[14] 高蓉蓉, 徐芳, 祝绪, 等. 全血细胞衍生的炎症标志物对急性心力衰竭患者的长期预后价值[J]. 临床心血管病杂志, 2022, 38(12): 980-987. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2022.12.010
[15] Kurtul A, Ornek E. Platelet to lymphocyte ratio in cardiovascular diseases: a systematic review[J]. Angiology, 2019, 70(9): 802-818.
[16] 刘先玲, 洪牮, 许迪. 射血分数保留的老年心力衰竭病人血小板/淋巴细胞比值与左心室舒张功能的相关性分析[J]. 实用老年医学, 2022, 36(10): 1001-1005. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLA202210007.htm
[17] Avci A, Alizade E, Fidan S, et al. Neutrophil/lymphocyte ratio is related to the severity of idiopathic dilated cardiomyopathy[J]. Scandinavian Cardiovasc J, 2014, 48(4): 202-208.
[18] Araújo FDR, Silva RF, Lima Oliveira C, et al. Neutrophil-to-lymphocyte ratio used as prognostic factor marker for dilated cardiomyopathy in childhood and adolescence[J]. Annals of Pediatric Cardiology, 2019, 12(1): 18.
[19] 刘昭君, 周晓莉. 基于系统性炎症指标构建的列线图可预测心力衰竭患者的不良结局[J]. 南方医科大学学报, 2022, 42(8): 1149-1158. https://www.cnki.com.cn/Article/CJFDTOTAL-DYJD202208006.htm
[20] Ain QU, Sarfraz M, Prasesti GK, et al. Confounders in identification and analysis of inflammatory biomarkers in cardiovascular diseases[J]. Biomolecules, 2021, 11(10): 1464.
[21] 李莹莹, 罗瑶, 柴坷, 等. 跟着指南走—心力衰竭模型对住院心力衰竭患者院内死亡的预测价值[J]. 中国循环杂志, 2021, 36(9): 874-879. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202109009.htm
[22] Carr E, Bendayan R, Bean D, et al. Evaluation and improvement of the National Early Warning Score(NEWS2) for COVID-19: a multi-hospital study[J]. BMC Medicine, 2021, 19(1): 23.
-
图(2)
表(3)
计量
- 文章访问数: 1104
- PDF下载数: 79
- 施引文献: 0