The Association Between the Baseline and the Change in Neutrophil-to-Lymphocyte Ratio and Short-Term Mortality in Patients With Acute Respiratory Distress Syndrome

Abstract

Background: Two previous studies have shown that increased neutrophil to lymphocyte ratio (NLR) is associated with short-term prognosis in patients with acute respiratory distress syndrome (ARDS), but it is usually assessed as a single threshold value at baseline. We investigated the relationship between the baseline and the early change in NLR and 30-day mortality in patients with ARDS to evaluate the prognostic value of NLR baseline and NLR changes during the first 7 days after ICU admission.Methods: This is a retrospective cohort study, with all ARDS patients diagnosed according to the Berlin definition from the Medical Information Mart for Intensive Care III (MIMIC-III) database. We calculated the NLR by dividing the neutrophil count by the lymphocyte count. The multivariable logistic regression analysis was used to investigate the relationship between the baseline NLR and short-term mortality. Then the generalized additive mixed model was used to compare trends in NLR over time among survivors and non-survivors after adjusting for potential confounders.Results: A total of 1164 patients were enrolled in our study. Multivariable logistic regression analysis showed that after adjusting for confounders, elevated baseline NLR was a significant risk factor predicting 30-day mortality (OR 1.02, 95%CI 1.01, 1.03, P = 0.0046) and hospital mortality (OR 1.02, 95%CI 1.01, 1.03, P = 0.0003). The result of the generalized additive mixed model showed that the NLR decreased in the survival group and increased in the non-survival group gradually within 7 days after ICU admission. The difference between the two groups showed a trend of increase gradually and the difference increased by an average of 0.67 daily after adjusting for confounders.Conclusions: We confirmed that there was a positive correlation between baseline NLR and short-term mortality, and we found significant differences in NLR changes over time between the non-survival group and the survival group. The early increase in NLR was associated with short-term mortality in ARDS patients.

A propensity score‐matching analysis of angiotensin‐converting enzyme inhibitor and angiotensin receptor blocker exposure on in‐hospital mortality in patients with acute respiratory failure

“…However, these codes representing pulmonary insufficiency and respiratory failure are not in agreement with the definition of ARDS. Berlin definition was more widely used than ICD‐9 code in these studies 18,41–45 . Unfortunately, the large number of missing information for oxygen concentration (itemid = “50816”) or oxygen flow (itemid = “50815”) in the MIMICIII database, 362,668/490,629 (73.92%) of oxygen concentration and 478,321/490,629 (97.49%) of oxygen flow (Table ), make it difficult to calculate the PaO 2 /FiO 2 ratio which is the core factor of Berlin definition.…”

Development and Validation of Nomogram to Predict Long-Term Prognosis of Critically Ill Patients with Acute Myocardial Infarction

“…Laboratory tests included counting the number of or estimating the levels of white blood cells (WBC), hemoglobin, platelets, anion gap, sodium, potassium, chloride, bicarbonate, creatinine, blood urea nitrogen (BUN), prothrombin time, activated partial thromboplastin time, troponin T (cTnT), and lactate within the first 24 h after ICU admission. 17,18 Interventions involved the use of vasopressor medicine, dialysis, mechanical ventilation, and percutaneous coronary intervention (PCI). Except for cTnT and lactate, the missing values of the other variables were all within 10%, which were filled by multivariate multiple imputation with chained equations; by contrast, cTnT and lactate were regarded as dummy variables in the statistical analysis to reduce the possible bias of simple filling.…”

Association between body mass index and short-term mortality in patients with intra-abdominal infections: a retrospective, single-centre cohort study using the Medical Information Mart for Intensive Care database

“…The data cover 53 423 distinct hospital admissions for adult patients admitted to critical care units between 2001 and 2012, and many studies have been conducted to explore the clinical features of ICU patients using the database. [14][15][16]…”