Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30-day all-cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty-day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60–4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77–3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90–3.33). The c-statistic for NLR in patients with low-risk PE was 0.78 (95% CI: 0.69–0.86). Respective numbers were 0.66 (95% CI: 0.63–0.69) and 0.68 (95% CI: 0.59–0.76) for intermediate-risk and high-risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5–98.7) and negative predictive value (99.7%; 95% CI: 99.5–99.8) than sPESI alone (87.1%; 95% CI: 83.9–90.3, and 98.7%; 95% CI: 98.4–99.1, respectively) for 30-day mortality. The NLR is a significant prognostic marker for 30-day mortality in PE patients, especially useful to identify patients with very low-risk PE.

中文翻译：

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血细胞指标对肺栓塞的预后价值


急性肺栓塞（PE）的预测需要可靠的标志物。虽然中性粒细胞与淋巴细胞比率 (NLR)、血小板与淋巴细胞比率 (PLR) 和全身免疫炎症指数 (SII) 等细胞指标似乎很有前景，但它们在 PE 预测中的实用性需要进一步探索。我们利用来自 RIETE 登记处和洛约拉大学医学中心 (LUMC) 的数据，使用逻辑回归模型评估 NLR、PLR 和 SII 在急性 PE 中的预后价值。主要结局是 30 天全因死亡率。我们将它们的预后价值与单独的简化肺栓塞严重指数 (sPESI) 进行了比较。我们纳入了来自 RIETE 的 10 085 名患者和来自 LUMC 的 700 名患者。 30 天死亡率分别为 4.6% 和 8.3%。在多变量分析中，NLR 升高 (>7.0) 与死亡率增加相关（调整后比值比 [aOR]：3.46；95% CI：2.60–4.60），优于 PLR > 220（aOR：2.36；95% CI：1.77） –3.13），SII > 1600（aOR：2.52；95% CI：1.90-3.33）。低风险 PE 患者 NLR 的 c 统计值为 0.78（95% CI：0.69-0.86）。中危和高危患者的数字分别为 0.66（95% CI：0.63-0.69）和 0.68（95% CI：0.59-0.76）。这些发现也反映在 LUMC 队列中。在 RIETE 的 9810 名血压正常患者中，sPESI 得分为 0 且 NLR ≤ 7.0 的患者（占人群的 35%）显示出较高的敏感性（97.1%；95% CI：95.5–98.7）和阴性预测值（99.7%；95） 30 天死亡率的百分比 CI：99.5–99.8）高于单独 sPESI（分别为 87.1%；95% CI：83.9–90.3 和 98.7%；95% CI：98.4–99.1）。 NLR 是 PE 患者 30 天死亡率的重要预后标志物，对于识别极低风险 PE 患者特别有用。