Study on the value of platelet-lymphocyte ratio combined with Sequential Organ Failure Assessment score for evaluating short-term prognosis of in-hospital cardiac arrest patients_West China Medical Journal

Authors：

CAO Jingshi ¹ , LIU Junzhao ¹ , YE Sheng ¹ , HE Yarong ^1,2,3 , JIN Rui ¹ ,  CAO Yu ^1,2,3

1. Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Disaster Medicine Center, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CAO Yu, Email: caoyu@wchscu.cn

Keywords：

Platelet-lymphocyte ratio; In-hospital cardiac arrest; Return of spontaneous circulation; Prognosis

DOI：

10.7507/1002-0179.201911064

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Objective To explore the value of platelet-lymphocyte ratio (PLR) after return of spontaneous circulation (ROSC) combined with Sequential Organ Failure Assessment (SOFA) for estimating the short-term prognosis of ROSC patients suffered from in-hospital cardiac arrest (IHCA).Methods ROSC adult patients who suffered from IHCA during treatment in the Emergency Department of West China Hospital of Sichuan University between 00:00, August 1st, 2010 and 23:59, July 31st, 2018 were included retrospectively. The basic and clinical data of patients were collected. Patients were divided into survival group and death group according to the 28-day prognosis. Through logistic regression and receiver operating characteristic (ROC) curve analysis, the efficacy of PLR after ROSC combined with SOFA score in predicting the 28-day prognosis of IHCA patients was explored.Results A total of 199 patients were included, including 135 males and 64 females, with a mean age of (60.45±17.52) years old. There were 154 deaths and 45 survivors within 28 days. There were statistically significant differences between the survival group and the death group in terms of epinephrine dosage, SOFA score, proportion of patients complicated with respiratory diseases, and post-ROSC laboratory indexes including PLR, hemoglobin, red blood cell count, lymphocyte count, indirect bilirubin, serum albumin, cholesterol, and activated partial thrombin time (P<0.05). The result of multivariate logistic regression analysis showed that epinephrine dosage [odds ratio (OR)=1.177, 95% confidence interval (CI) (1.024, 1.352), P=0.022], SOFA score [OR=1.536, 95%CI (1.173, 2.010), P=0.002], PLR after ROSC [OR=1.011, 95%CI (1.004, 1.018), P=0.002] were independent risk factors for ROSC patients’ death on day 28. The areas under the ROC curve of epinephrine dosage, SOFA score and PLR after ROSC were 0.702, 0.703 and 0.737, respectively, to predict the patients’ 28-day outcome. Combining the epinephrine dosage and PLR after ROSC with SOFA score respectively to predict the 28-day outcome of patients, the areas under the ROC curve were 0.768 and 0.813, respectively.Conclusions The significant increase of PLR after ROSC is an independent risk factor for death within 28 days after ROSC. The combined application of PLR after ROSC and SOFA score in the 28-day outcome prediction of patients has better predictive efficacy.

Citation： CAO Jingshi, LIU Junzhao, YE Sheng, HE Yarong, JIN Rui, CAO Yu. Study on the value of platelet-lymphocyte ratio combined with Sequential Organ Failure Assessment score for evaluating short-term prognosis of in-hospital cardiac arrest patients. West China Medical Journal, 2020, 35(9): 1068-1073. doi: 10.7507/1002-0179.201911064 Copy

1.	Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update a report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
2.	马宇洁, 杨兴易. 复苏后多器官功能障碍综合征的研究进展. 第二军医大学学报, 2004, 25(11): 1186-1189.
3.	张海宏, 曹钰, 曾智. 白藜芦醇预适应对心脏骤停后大鼠心脏功能的影响. 四川大学学报(医学版), 2016, 47(2): 152-158.
4.	Wu Y, Chen Y, Yang X, et al. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol, 2016, 36: 94-99.
5.	Mertoglu C, Gunay M. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes Metab Syndr, 2017, 11(Suppl 1): S127-S131.
6.	Yao C, Liu X, Tang Z. Prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for hospital mortality in patients with AECOPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 2285-2290.
7.	曾理, 胡祖鹏. SOFA评分的临床意义及其在临床研究中的应用. 中国临床医学, 2001, 1: 84-85.
8.	Meng X, Wei G, Chang Q, et al. The platelet-to-lymphocyte ratio, superior to the neutrophil-to-lymphocyte ratio, correlates with hepatitis C virus infection. Int J Infect Dis, 2016, 45: 72-77.
9.	Turkmen K, Erdur FM, Ozcicek FA, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int, 2013, 17(3): 391-396.
10.	Zhao Z, Liu J, Wang J, et al. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with chronic hepatitis B virus (HBV) infection. Int Immunopharmacol, 2017, 51: 1-8.
11.	Patel VH, Vendittelli P, Garg R, et al. Neutrophil-lymphocyte ratio: a prognostic tool in patients with in-hospital cardiac arrest. World J Crit Care Med, 2019, 8(2): 9-17.
12.	Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation, 2008, 118(23): 2452-2483.
13.	Nagase M, Sakurai A, Sugita A, et al. Oxidative stress and abnormal cholesterol metabolism in patients with post-cardiac arrest syndrome. J Clin Biochem Nutr, 2017, 61(2): 108-117.
14.	Mentzelopoulos SD, Zakynthinos SG. Post-cardiac arrest syndrome: pathological processes, biomarkers and vasopressor support, and potential therapeutic targets. Resuscitation, 2017, 121: A12-A14.
15.	王长远, 秦俭, 孙长怡, 等. 心肺复苏后多器官功能障碍综合征. 实用医学杂志, 2007, 23(1): 6-8.
16.	徐健, 赵世杰, 牛一蒙, 等. 血小板淋巴细胞比值与老年急性冠状动脉综合征患者冠状动脉介入治疗围术期心肌梗死的相关分析及其预测价值. 中国医科大学学报, 2019, 48(8): 719-725.
17.	Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med, 2003, 348(2): 138-150.
18.	赵梦龙, 郭凯, 张源波, 等. 心脏骤停自主循环恢复患者预后的多因素Cox生存分析. 中国急救医学, 2017, 37(2): 149-152.
19.	何光辉, 梁彦平, 刘丽疆, 等. 心肺复苏时限与预后的探讨. 临床急诊杂志, 2015, 16(6): 437-439.
20.	江朋, 胡海, 何亚荣, 等. 影响心肺复苏后自主循环恢复患者早期生存时间的相关因素分析. 华西医学, 2015, 30(6): 1027-1030.
21.	Wang J, Ma Q, Zhang H, et al. Predictors of survival and neurologic outcome for adults with extracorporeal cardiopulmonary resuscitation: a systemic review and meta-analysis. Medicine (Baltimore), 2018, 97(48): e13257.
22.	熊成龙, 赫杰, 邬善敏, 等. 肝脏缺血再灌注损伤与肝微循环变化. 微循环学杂志, 1999, 9(2): 10-12.
23.	Szabo G, Romics L, Frendl G. Liver in sepsis and systemic inflammatory response syndrome. Clin Liver Dis, 2002, 6(4): 1045-1066.
24.	Rolando N, Wade J, Davalos M, et al. The systemic inflammatory response syndrome in acute liver failure. Hepatology, 2000, 32(4): 734-739.
25.	吕晓. 6项肝功能指标检测在诊断肝病方面的临床价值分析. 当代医药论丛, 2014, 18: 42-43.

1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update a report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
2. 马宇洁, 杨兴易. 复苏后多器官功能障碍综合征的研究进展. 第二军医大学学报, 2004, 25(11): 1186-1189.
3. 张海宏, 曹钰, 曾智. 白藜芦醇预适应对心脏骤停后大鼠心脏功能的影响. 四川大学学报(医学版), 2016, 47(2): 152-158.
4. Wu Y, Chen Y, Yang X, et al. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol, 2016, 36: 94-99.
5. Mertoglu C, Gunay M. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes Metab Syndr, 2017, 11(Suppl 1): S127-S131.
6. Yao C, Liu X, Tang Z. Prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for hospital mortality in patients with AECOPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 2285-2290.
7. 曾理, 胡祖鹏. SOFA评分的临床意义及其在临床研究中的应用. 中国临床医学, 2001, 1: 84-85.
8. Meng X, Wei G, Chang Q, et al. The platelet-to-lymphocyte ratio, superior to the neutrophil-to-lymphocyte ratio, correlates with hepatitis C virus infection. Int J Infect Dis, 2016, 45: 72-77.
9. Turkmen K, Erdur FM, Ozcicek FA, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int, 2013, 17(3): 391-396.
10. Zhao Z, Liu J, Wang J, et al. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with chronic hepatitis B virus (HBV) infection. Int Immunopharmacol, 2017, 51: 1-8.
11. Patel VH, Vendittelli P, Garg R, et al. Neutrophil-lymphocyte ratio: a prognostic tool in patients with in-hospital cardiac arrest. World J Crit Care Med, 2019, 8(2): 9-17.
12. Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation, 2008, 118(23): 2452-2483.
13. Nagase M, Sakurai A, Sugita A, et al. Oxidative stress and abnormal cholesterol metabolism in patients with post-cardiac arrest syndrome. J Clin Biochem Nutr, 2017, 61(2): 108-117.
14. Mentzelopoulos SD, Zakynthinos SG. Post-cardiac arrest syndrome: pathological processes, biomarkers and vasopressor support, and potential therapeutic targets. Resuscitation, 2017, 121: A12-A14.
15. 王长远, 秦俭, 孙长怡, 等. 心肺复苏后多器官功能障碍综合征. 实用医学杂志, 2007, 23(1): 6-8.
16. 徐健, 赵世杰, 牛一蒙, 等. 血小板淋巴细胞比值与老年急性冠状动脉综合征患者冠状动脉介入治疗围术期心肌梗死的相关分析及其预测价值. 中国医科大学学报, 2019, 48(8): 719-725.
17. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med, 2003, 348(2): 138-150.
18. 赵梦龙, 郭凯, 张源波, 等. 心脏骤停自主循环恢复患者预后的多因素Cox生存分析. 中国急救医学, 2017, 37(2): 149-152.
19. 何光辉, 梁彦平, 刘丽疆, 等. 心肺复苏时限与预后的探讨. 临床急诊杂志, 2015, 16(6): 437-439.
20. 江朋, 胡海, 何亚荣, 等. 影响心肺复苏后自主循环恢复患者早期生存时间的相关因素分析. 华西医学, 2015, 30(6): 1027-1030.
21. Wang J, Ma Q, Zhang H, et al. Predictors of survival and neurologic outcome for adults with extracorporeal cardiopulmonary resuscitation: a systemic review and meta-analysis. Medicine (Baltimore), 2018, 97(48): e13257.
22. 熊成龙, 赫杰, 邬善敏, 等. 肝脏缺血再灌注损伤与肝微循环变化. 微循环学杂志, 1999, 9(2): 10-12.
23. Szabo G, Romics L, Frendl G. Liver in sepsis and systemic inflammatory response syndrome. Clin Liver Dis, 2002, 6(4): 1045-1066.
24. Rolando N, Wade J, Davalos M, et al. The systemic inflammatory response syndrome in acute liver failure. Hepatology, 2000, 32(4): 734-739.
25. 吕晓. 6项肝功能指标检测在诊断肝病方面的临床价值分析. 当代医药论丛, 2014, 18: 42-43.

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Study on the value of platelet-lymphocyte ratio combined with Sequential Organ Failure Assessment score for evaluating short-term prognosis of in-hospital cardiac arrest patients

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