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J Korean Soc Emerg Med > Volume 30(6); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(6): 555-562.
응급실을 통해 중환자실에 입원한 노인 환자에서 예후 예측 인자로서의 호중구 대 림프구 비율의 유용성
김상규1 , 박정호1 , 오상희1 , 박상현1 , 김한준2 , 김수현3 , 김성욱3 , 주종호3 , 최승필3 , 오재훈3
1여의도성모병원 응급의학과
2서울성모병원 응급의학과
3은평성모병원 응급의학과
Usefulness of the neutrophil-to-lmphocyte ratio as a prognostic predictor in elderly patients admitted to the intensive care unit through emergency department
Sang Kyu Kim1 , Jeoung Ho Park1 , Sanghee Oh1 , Sang Hyun Park1 , Han Joon Kim2 , Soo Hyun Kim3 , Sung Wook Kim3 , Jongho Zhu3 , Seung Pill Choi3 , Jae Hun Oh3
1Department of Emergency Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Emergency Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Department of Emergency Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence  Jae Hun Oh ,Tel: 02-2030-4603, Fax: 02-2030-2923, Email: emojh@catholic.ac.kr,
Received: June 18, 2019; Revised: September 20, 2019   Accepted: October 11, 2019.  Published online: December 31, 2019.
ABSTRACT
Objective:
The purpose of this study was to test the hypothesis that an increase in the neutrophil-to-lymphocyte ratio (NLR) increases the risk of in-hospital density in patients aged 65 and older, who are hospitalized in intensive care through the emergency rooms.
Method:
A retrospective medical record study was conducted on elderly patients who were admitted to intensive care units via the emergency room. The exclusion criteria were data loss, intensive care unit reentry, cerebrovascular accidents, hematologic disease, and trauma cases.
Results:
The study included 526 patients; the mean age was 79, and 261 (49.6%) were male. The in-hospital mortality was 18.4% (97 patients). The initial NLR was higher in the non-survivor group than the survivor group, but the difference was not statistically significant (9.82±11.02 vs. 11.48±6.11, P=0.080). In multivariate logistic analysis, the initial NLR had no statistical significance, and the odd ratio was increased from one day later. Comparing the receiver operating characteristic curve of the NLR and Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores, the NLR showed an increase in the area of under curve (AUC) value over time as well as the highest AUC with the SAPS II scores.
Conclusion:
In elderly adults, early NLR was found to have weak power to predict in-hospital mortality. Over time, the NLR values more than two days after intensive care unit admission may be useful in predicting the in-hospital mortality for older patients. This may be due to the delay in the immune response and the complex medical history.
Key words: In-hospital mortality; Neutrophil count; Lymphocyte count; Elderly patient; Intensive care unit
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