Background: The neutrophil/lymphocyte ratio (NLR) has been associated as a predictor for increased mortality in critically ill patients. We sought to determine the relationship between NLR and outcomes in adult trauma patients with severe hemorrhage requiring the initiation of massive transfusion protocol (MTP). We hypothesized that the NLR would be a prognostic indicator of mortality in this population. Methods: This was a multi-institutional retrospective cohort study of adult trauma patients (>=18 years) with severe hemorrhage who received MTP between November 2014 - November 2015. Differentiated blood cell counts obtained at days 3 and 10 were used to obtain NLR. Receiver operating characteristic (ROC) curve analysis assessed the predictive capacity of NLR on mortality. To identify the effect of NLR on survival, Kaplan-Meier (KM) survival analysis and Cox regression models were used. Results: A total of 285 patients with severe hemorrhage managed with MTP were analyzed from 6 participating institutions. Most (80%) were male, 57.2% suffered blunt trauma. Median (IQR) age, Injury Severity Score, and Glasgow Coma Scale were 35 (25-47), 25 (16-36), 9 (3-15), respectively. Using ROC curve analysis, optimal NLR cutoff values of 8.81 at day 3 and 13.68 at day 10 were calculated by maximizing the Youden index. KM curves at day 3 (p = 0.05) and day 10 (p = 0.02) revealed an NLR greater than or equal to these cutoff values as a marker for increased in-hospital mortality. Cox regression models failed to demonstrate an NLR over 8.81 as predictive of in-hospital mortality at day 3 (p = 0.056) but was predictive for mortality if NLR was greater than 13.68 at day 10 (p=0.036). Conclusions: NLR is strongly associated with early mortality in patients with severe hemorrhage managed with MTP. Further research is needed to focus on factors that can ameliorate NLR in this patient population. Level of evidence: Prognostic study, Level III (C) 2017 Lippincott Williams & Wilkins, Inc.
from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2vlnCUr
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Δημοφιλείς αναρτήσεις
-
Oral Candida colonization in xerostomic post‐radiotherapy head and neck cancer patients 16h ... Oral Candida colonization in xerostomic post...
-
Hard to believe, but there was a time we were without the most necessary EMS tools. That all changed, thanks to these creative minds. fro...
-
U.S. Department of Veterans Affairs Research News from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2iVEnBB
-
Clinical application of stress echocardiography for valvular heart disease Abstract Stress echocardiography is widely used to assess several...
-
MedStar replaced training diagrams with drone flyovers of the driving course to better demonstrate how to navigate a complicated driving sc...
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου