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Neutrophil-lymphocyte ratio:A prognostic tool in patients with inhospital cardiac arrest

World Journal of Critical Care Medicine 2019年第2期8卷 9-17页

作者： Vishal H Patel Philip Vendittelli Rajat Garg Susan Szpunar thomas lalonde John Lee Howard Rosman Rajendra H Mehta Hussein Othman Department of Cardiovascular Medicine Ascension-St John Hospital and Medical Center Department of Internal Medicine Cleveland Clinic Department of Biomedical Investigations and Research Ascension-St John Hospital and Medical Center Department of Critical Care Medicine Ascension-St John Hospital and Medical Center Duke Clinical Research Institute Duke University Medical Center

BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with *** To determine the prognostic significance of NLR in patients suffering IHCA who achieve *** A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came *** We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were ***-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of *** An NLR ≥ 4.5 may

关键词： Neutrophil-lymphocyte ratio In-hospital cardiac arrest Prognosis Lactate Asystole Ventricular fibrillation Pulseless electrical alternans Pulseless ventricular tachycardia

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