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응급실을 통해 중환자실에 입원한 노인 환자에서 예후 예측 인자로서의 호중구 대 림프구 비율의 유용성

Usefulness of the neutrophil-to-lmphocyte ratio as a prognostic predictor in elderly patients admitted to the intensive care unit through emergency department

대한응급의학회지 2019년 30권 6호 p.555 ~ 562
김상규 ( Kim Sang-Kyu ) - 여의도성모병원 응급의학과

박정호 ( Park Jeoung-Ho ) - 여의도성모병원 응급의학과
오상희 ( Oh Sang-Hee ) - 여의도성모병원 응급의학과
박상현 ( Park Sang-Hyun ) - 여의도성모병원 응급의학과
김한준 ( Kim Han-Joon ) - 서울성모병원 응급의학과
김수현 ( Kim Soo-Hyun ) - 은평성모병원 응급의학과
김성욱 ( Kim Sung-Wook ) - 은평성모병원 응급의학과
주종호 ( Zhu Jong-Ho ) - 은평성모병원 응급의학과
최승필 ( Choi Seung-Phill ) - 은평성모병원 응급의학과
오재훈 ( Oh Jae-Hun ) - 은평성모병원 응급의학과

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.

키워드

In-hospital mortality; Neutrophil count; Lymphocyte count; Elderly patient; Intensive care unit
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