Value of neutrophil-to-lymphocyte ratio and prognostic trophic index in prognostic assessment in elderly patients with acute pulmonary embolism
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摘要: 目的 探讨入院早期中性粒细胞与淋巴细胞比值(NLR)和预后营养指数(PNI)与老年急性肺栓塞患者预后的关系。 方法 回顾性分析2019年6月—2022年9月首次确诊的270例老年急性肺栓塞患者的资料，并进行定期随访，根据患者的临床结局分为预后良好组(218例)和预后不良组(52例)。采用LASSO回归来筛选与预后不良相关的预测变量，并构建多因素logistic回归模型来评估预后不良的影响因素。 结果 在平均随访23.00(15.00，36.00)个月内，19.26%的患者经历了不良临床结局。通过LASSO回归筛选，确定了N末端脑钠肽前体、D-二聚体、白蛋白、NLR和PNI这5个预测变量，依据这些预测变量构建的多因素logistic回归模型显示，NLR(OR=1.732，95%CI 1.217~2.466，P=0.002)、PNI(OR=0.616，95%CI 0.428~0.886，P=0.009)是老年急性肺栓塞患者预后不良的独立影响因素。 结论 入院早期高NLR和低PNI是老年急性肺栓塞患者预后不良的独立危险因素。
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关键词:
- 老年 /
- 急性肺栓塞 /
- 中性粒细胞与淋巴细胞比值 /
- 预后营养指数 /
- 临床结局
Abstract: Objective To investigate the relationship between neutrophil-to-lymphocyte ratio(NLR) and prognostic nutritional index(PNI) in early admission and the prognosis of elderly patients with acute pulmonary embolism. Methods Baseline data of 270 elderly patients with acute pulmonary embolism diagnosed for the first time from June 2019 to September 2022 were retrospectively analyzed and followed up regularly, and patients were divided into a good prognosis group(n=218) and a poor prognosis group(n=52) according to their clinical outcomes. LASSO regression was used to screen predictor variables associated with poor prognosis, and a multifactorial logistic regression model was constructed to assess the influencing factors of poor prognosis. Results During a mean follow-up of 23.00(15.00, 36.00)months, 19.26% of patients experienced adverse clinical outcomes. Five predictor variables, such as NT-proBNP, D-dimer, albumin, NLR, and PNI, were identified by LASSO regression screening, and a multifactorial logistic regression model showed that NLR(OR=1.732, 95%CI1.217-2.466, P=0.002), PNI(OR=0.616, 95%CI0.428-0.886, P=0.009) were independent influences on poor prognosis in elderly patients with acute pulmonary embolism. Conclusion High NLR and low PNI early in admission are independent risk factors for poor prognosis in elderly patients with acute pulmonary embolism. -
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表 1 一般情况
Table 1. General data
例(%), M(P25, P75), X±S 项目 预后良好组(218例) 预后不良组(52例) 统计值 P 男性 119(54.59) 35(67.31) 2.772 0.096 年龄/岁 71.55±7.31 72.12±6.56 -0.510 0.610 BMI/(kg/m2) 24.52±3.52 24.44±3.93 0.136 0.892 冠心病 119(54.59) 31(59.62) 0.430 0.512 高血压 104(47.71) 26(50.00) 0.088 0.766 糖尿病 35(16.06) 11(21.15) 0.772 0.380 高脂血症 55(25.23) 15(28.85) 0.286 0.593 慢性阻塞性肺病 24(11.01) 9(17.31) 1.553 0.213 下肢静脉血栓形成 113(51.83) 28(53.85) 0.068 0.794 收缩压/mmHg 130.42±22.15 125.65±23.31 1.379 0.169 舒张压/mmHg 71.05±13.72 68.69±14.50 1.102 0.272 心率/(次/min) 82.00(72.00，89.25) 84.50(75.25，96.00) -1.726 0.085 白细胞计数/(×109/L) 7.41±2.33 8.01±2.65 -1.626 0.105 血红蛋白/(g/L) 127.04±17.75 124.14±17.13 1.068 0.286 血小板计数/(×109/L) 214.92±47.56 219.85±62.99 -0.529 0.598 中性粒细胞计数/(×109/L) 4.92(3.34，6.41) 5.99(4.81，6.95) -3.362 0.001 淋巴细胞计数/(×109/L) 1.07(0.84，1.50) 0.80(0.61，1.42) 2.196 0.029 单核细胞计数/(×109/L) 0.41±0.20 0.42±0.18 -0.307 0.759 白蛋白/(g/L) 39.19±3.71 34.45±3.03 9.676 ＜0.001 总胆红素/(μmol/L) 13.69±4.78 14.43±7.57 -0.679 0.500 谷丙转氨酶/(U/L) 30.18±8.02 32.19±13.91 -1.006 0.319 尿素氮/(mmol/L) 5.66±2.23 6.07±1.73 -1.232 0.219 尿酸/(μmol/L) 336.15(271.00，389.47) 328.05(295.05，405.25) -0.948 0.344 肌酐/(μmol/L) 62.48±13.67 60.41±13.30 0.985 0.326 胱抑素C/(mg/L) 0.83(0.73，0.95) 0.80(0.68，0.96) 1.746 0.082 血钠/(mmol/L) 138.83±3.58 139.70±3.69 -1.557 0.121 血钙/(mmol/L) 2.37±0.16 2.34±0.16 1.282 0.201 纤维蛋白原/(g/L) 3.86±0.88 4.14±1.23 -1.554 0.125 D-二聚体/(μg/mL) 1.74(1.02，2.57) 1.81(0.90，2.95) -4.458 ＜0.001 NT-proBNP/(pg/mL) 184.00(72.83，434.45) 798.50(389.10，1124.25) -4.372 ＜0.001 肌钙蛋白I/(pg/mL) 55.50(34.00，79.00) 66.00(39.00，100.25) -2.280 0.027 NLR 3.41(2.37，4.81) 6.37(5.40，8.32) -11.234 ＜0.001 PNI 46.75±4.62 39.49±3.07 13.727 ＜0.001 
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表 2 预后不良的多因素logistic回归分析
Table 2. Multivariate logistic regression analysis of poor prognosis
变量 P OR 95%CI NLR 0.002 1.732 1.217~2.466 PNI 0.009 0.616 0.428~0.886 NT-proBNP 0.021 1.003 1.002~1.004 D-二聚体 0.005 1.162 1.023~1.320 白蛋白 0.001 0.886 0.631~1.245
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