探究中性粒细胞与白蛋白比值(NAR)对肺内源性急性呼吸窘迫综合征(ARDSp)预后的预测价值

Prognostic Value of the Neutrophil to Albumin Ratio for Predicting Mortality in Pa-tients with Acute Respiratory Distress Syn-drome Originating from Pulmonary Disease

摘要: 目的：探讨中性粒细胞与白蛋白比值(NAR)对肺内源性急性呼吸窘迫综合征(ARDSp)预后的预测价值。方法：回顾性分析126例ARDSp患者的临床资料。根据28天转归情况将患者分为生存者组及非生存者组，收集一般资料、实验室检查等指标，Logistic回归分析28 d死亡的独立危险因素，受试者操作特征曲线(ROC曲线)评价预测价值。结果：纳入ARDSp患者126例，非生存者组59例，生存者组67例，28天死亡率为46.83%。非生存者组年龄、男性患者比例、血小板计数、中性粒细胞、SOFA评分、APACHEII评分、中性粒细胞与白蛋白比值高于生存者组，白蛋白低于生存者组，差异有统计学意义(P < 0.05)。多因素Logstic回归分析显示，NAR是ARDSp患者28天死亡的独立危险因素(OR = 1.800, 95%CI 1.366~2.374, P < 0.001)。ROC曲线分析显示，NAR的ROC曲线下面积(AUC)为0.754，最佳截断值0.323。当NAR > 0.323时，ARDSp患者死亡率较高。并且NAR的ROC曲线下面积大于中性粒细胞(AUC = 0.713)、白蛋白(AUC = 0.696)、APACHE II (AUC = 0.715)，以及SOFA的ROC曲线下面积(AUC = 0.665)。结论：NAR对ARDSp患者28天预后有较好的预测价值，是28天死亡的独立危险因素。

Abstract: Objective: To investigate the prognostic value of neutrophil to albumin ratio (NAR) in patients with pulmonary endogenous acute respiratory distress syndrome (ARDSp). Methods: The clinical data of 126 patients with ARDSp were analyzed retrospectively. The patients were divided into survival group and non-survivor group according to the 28 day outcome. General data, laboratory tests and other indicators were collected. The independent risk factors of 28 day death were analyzed by lo-gistic regression, and the predictive value was evaluated by the receiver operating characteristic curve (ROC curve). Results: 126 patients with ARDSP were included, 59 in the non-survivor group and 67 in the survivor group. The 28-day mortality rate was 46.83%. The age, proportion of male patients, platelet count, neutrophil, SOFA score, APACHEII score, ratio of neutrophil to albumin in the non-survivor group were higher than those in the survivor group, and albumin was lower than that in the survivor group, with statistically significant difference (P < 0.05). Multivariate logistic regression analysis showed that NAR was an independent risk factor for 28-day death of ARDSP pa-tients (OR = 1.800, 95%CI 1.366~2.374, P < 0.001). The ROC curve analysis shows that the area un-der the ROC curve (AUC) of NAR is 0.754, and the best cutoff value is 0.323. When NAR > 0.323, the mortality of patients with ARDSp was higher. The area under the ROC curve of NAR is larger than that of neutrophils (AUC = 0.713), albumin (AUC = 0.696), APACHE II (AUC = 0.715), and SOFA (AUC = 0.665). Conclusion: NAR has a good predictive value for the 28 day prognosis of ARDSp patients and is an independent risk factor for 28 day mortality.