Table_2_The Neutrophil-to-Lymphocyte Ratio Is an Important Indicator Predicting In-Hospital Death in AMI Patients.DOCX

Objective: To explore the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the short-term prognosis of NSTEMI and STEMI.
Methods: This study was a single-center, retrospective and observational study. 2618 patients including 1289 NSTMI and 1329 STEMI patients were enrolled from June 2013 to February 2018 in Zhongda Hospital, Southeast University. The demographic information, clinical characteristics, medical history, laboratory examination, treatment, and outcome of individuals at admission and during hospitalization were extracted from the electronic medical record system. Outcome was defined as the all-cause death during hospitalization.
Results: (1) In the NSTEMI group, the ability of NLR in predicting in-hospital death (AUC = 0.746) was higher than the neutrophil-monocyte ratio (NMR) (AUC = 0.654), the platelet-lymphocyte ratio (PLR) (AUC = 0.603) and the lymphocyte-monocyte ratio (LMR) (AUC = 0.685), and also higher than AST (AUC = 0.621), CK (AUC = 0.595), LDH (AUC = 0.653) and TnI (AUC = 0.594). The AUC of NLR in the STEMI group was only 0.621. (2) The optimal cut-off value of NLR in NSTEMI group was 5.509 (Youden index = 0.447, sensitivity = 77.01%, specificity = 67.72%). After adjusting variables including age, sex, diabetes history, smoking history, LDL-C and Cr, the logistic regression showed that the patients with NLR>5.509 had higher hazard risk of death (HR4.356; 95%CI 2.552–7.435; P < 0.001) than the patients with NLR ≤ 5.509. (3) Stratification analysis showed that the in-hospital mortality of patients with NLR > 5.509 was 14.611-fold higher than those with NLR ≤ 5.509 in patients aged <76, much higher than the ratio in patients aged ≥ 76. For patients with creatinine levels ≤ 71, the in-hospital death risk in high NLR group was 10.065-fold higher than in low NLR group (95%CI 1.761–57.514, P = 0.009), while the HR was only 4.117 in patients with creatinine levels > 71. The HR in patients with or without diabetes were 6.586 and 3.375, respectively. The HR in smoking or no smoking patients were 6.646 and 4.145, respectively. The HR in patients with LDL-C ≥ 2.06 or <2.06 were 5.526 and 2.967 respectively.
Conclusion: Compared to NMR, PLR, and LMR, NLR had the best ability in predicting in-hospital death after NSTEMI. Age, creatinine, LDL-C, diabetes and smoking history were all important factors affecting the predictive efficiency in NSTEMI. NLR had the limited predictive ability in STEMI.

研究目的：探讨中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）对非ST段抬高型心肌梗死（non-ST segment elevation myocardial infarction, NSTEMI）与ST段抬高型心肌梗死（ST segment elevation myocardial infarction, STEMI）患者短期预后的预测价值。
研究方法：本研究为单中心回顾性观察性研究。于2013年6月至2018年2月，纳入东南大学附属中大医院的2618例患者，其中非ST段抬高型心肌梗死患者1289例、ST段抬高型心肌梗死患者1329例。从电子病历系统中提取受试者入院时及住院期间的人口学资料、临床特征、病史、实验室检查结果、治疗方案及转归结局。本研究的结局定义为住院期间全因死亡。
研究结果：（1）在非ST段抬高型心肌梗死组中，中性粒细胞与淋巴细胞比值（NLR）预测住院死亡的曲线下面积（AUC=0.746）高于中性粒细胞-单核细胞比值（neutrophil-monocyte ratio, NMR，AUC=0.654）、血小板-淋巴细胞比值（platelet-lymphocyte ratio, PLR，AUC=0.603）及淋巴细胞-单核细胞比值（lymphocyte-monocyte ratio, LMR，AUC=0.685），同时亦高于天冬氨酸转氨酶（aspartate aminotransferase, AST，AUC=0.621）、肌酸激酶（creatine kinase, CK，AUC=0.595）、乳酸脱氢酶（lactate dehydrogenase, LDH，AUC=0.653）及肌钙蛋白I（troponin I, TnI，AUC=0.594）。而ST段抬高型心肌梗死组中NLR的曲线下面积仅为0.621。
（2）非ST段抬高型心肌梗死组中NLR的最佳截断值为5.509（尤登指数=0.447，灵敏度=77.01%，特异度=67.72%）。在校正年龄、性别、糖尿病病史、吸烟史、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）及肌酐（creatinine, Cr）等变量后，Logistic回归分析显示，NLR>5.509的患者较NLR≤5.509的患者具有更高的住院死亡危险比（hazard ratio, HR=4.356；95%置信区间（confidence interval, CI）：2.552~7.435；P<0.001）。
（3）分层分析显示：在年龄＜76岁的患者中，NLR＞5.509者的住院死亡率为NLR≤5.509者的14.611倍，这一比值显著高于年龄≥76岁的患者亚组。在肌酐水平≤71的患者中，高NLR组患者的住院死亡风险为低NLR组的10.065倍（95%CI：1.761~57.514，P=0.009），而在肌酐水平＞71的患者亚组中，危险比仅为4.117。合并糖尿病与未合并糖尿病患者的危险比分别为6.586与3.375。吸烟与非吸烟患者的危险比分别为6.646与4.145。低密度脂蛋白胆固醇（LDL-C）≥2.06与＜2.06的患者亚组中，危险比分别为5.526与2.967。
研究结论：相较于中性粒细胞-单核细胞比值（NMR）、血小板-淋巴细胞比值（PLR）及淋巴细胞-单核细胞比值（LMR），中性粒细胞与淋巴细胞比值（NLR）对非ST段抬高型心肌梗死患者的住院死亡预测效能最优。年龄、肌酐水平、低密度脂蛋白胆固醇（LDL-C）、糖尿病病史及吸烟史均为影响非ST段抬高型心肌梗死患者NLR预测效能的重要因素。而NLR对ST段抬高型心肌梗死患者的预后预测能力较为有限。