Neutrophil to lymphocyte ratio and mortality in spinal epidural abscess.

Adult Aged Biomarkers / blood Epidural Abscess / blood Female Hospital Mortality Humans Lymphocytes / cytology Male Middle Aged Neutrophils / cytology
Neutrophil to lymphocyte ratio Platelet to lymphocyte ratio Prognosis Spinal epidural abscess Spine surgery Survival Systemic inflammation

Journal

The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732

Informations de publication

Date de publication:
07 2019
Historique:
received: 16 10 2018
revised: 25 01 2019
accepted: 07 02 2019
pubmed: 15 2 2019
medline: 21 4 2020
entrez: 15 2 2019
Statut: ppublish

Résumé

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio have been previously identified as markers for overall survival in oncology but remain heretofore unexplored in spinal epidural abscess (SEA). The purpose of this study was to determine the impact of these routinely collected assessments on 90-day mortality in SEA. Retrospective, case-control study. Patients 18 years or older diagnosed with SEA at 2 academic medical centers and 3 community hospitals. Ninety-day postdischarge and in-hospital mortality. Complete blood count with differential obtained on the day immediately preceding or on the day of admission was used to calculate platelet to lymphocyte and neutrophil to lymphocyte ratios. Multivariate analyses were used to determine if these ratios were independent risk factors for 90-day mortality. For 1,053 SEA patients included in the study, the rate of 90-day mortality was 134 (12.7%). The rate of 90-day mortality with neutrophil to lymphocyte ratio (≥8) was (20.5%) compared to (8.1%) with neutrophil to lymphocyte ratio <8. Neutrophil to lymphocyte ratio was positively associated with bacteremia, elevated erythrocyte sedimentation rate, and concurrent systemic infections (endocarditis, meningitis) and negatively associated with duration of symptoms prior to presentation. On multivariate analysis, elevated neutrophil to lymphocyte remained an independent risk factor for 90-day mortality (odds ratio=2.62, 95% confidence interval=1.66-4.17, p<.001). Platelet to lymphocyte ratio was not associated with 90-day mortality. Absolute neutrophil to lymphocyte ratio is a routinely collected but overlooked biomarker in patients with spinal epidural abscess that is a novel independent risk factor for 90-day mortality.

Sections du résumé

BACKGROUND CONTEXT
Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio have been previously identified as markers for overall survival in oncology but remain heretofore unexplored in spinal epidural abscess (SEA).
PURPOSE
The purpose of this study was to determine the impact of these routinely collected assessments on 90-day mortality in SEA.
STUDY DESIGN/SETTING
Retrospective, case-control study.
PATIENT SAMPLE
Patients 18 years or older diagnosed with SEA at 2 academic medical centers and 3 community hospitals.
OUTCOME MEASURES
Ninety-day postdischarge and in-hospital mortality.
METHODS
Complete blood count with differential obtained on the day immediately preceding or on the day of admission was used to calculate platelet to lymphocyte and neutrophil to lymphocyte ratios. Multivariate analyses were used to determine if these ratios were independent risk factors for 90-day mortality.
RESULTS
For 1,053 SEA patients included in the study, the rate of 90-day mortality was 134 (12.7%). The rate of 90-day mortality with neutrophil to lymphocyte ratio (≥8) was (20.5%) compared to (8.1%) with neutrophil to lymphocyte ratio <8. Neutrophil to lymphocyte ratio was positively associated with bacteremia, elevated erythrocyte sedimentation rate, and concurrent systemic infections (endocarditis, meningitis) and negatively associated with duration of symptoms prior to presentation. On multivariate analysis, elevated neutrophil to lymphocyte remained an independent risk factor for 90-day mortality (odds ratio=2.62, 95% confidence interval=1.66-4.17, p<.001). Platelet to lymphocyte ratio was not associated with 90-day mortality.
CONCLUSIONS
Absolute neutrophil to lymphocyte ratio is a routinely collected but overlooked biomarker in patients with spinal epidural abscess that is a novel independent risk factor for 90-day mortality.

Identifiants

DOI: 10.1016/j.spinee.2019.02.005 PMID: 30763714
pubmed: 30763714
pii: S1529-9430(19)30054-3
doi: 10.1016/j.spinee.2019.02.005
pii:
doi:

Substances chimiques

Biomarkers 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1180-1185

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

Aditya V Karhade (AV)

Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.

Kush C Shah (KC)

Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.

Akash A Shah (AA)

Department of Orthopedic Surgery, University of California, Los Angeles, CA 90095, USA.

Paul T Ogink (PT)

Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.

Sandra B Nelson (SB)

Department of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.

Joseph H Schwab (JH)

Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA. Electronic address: jhschwab@mgh.harvard.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Neutrophil to lymphocyte ratio and mortality...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Neutrophil to lymphocyte ratio and mortality...
questionsmedicales.fr › Facteurs biologiques › Marqueurs biologiques › Neutrophil to lymphocyte ratio and mortality...
questionsmedicales.fr › Maladies du système nerveux › Maladies du système nerveux central › Infections du système nerveux central › Infections des espaces méningés › Abcès épidural › Neutrophil to lymphocyte ratio and mortality...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Mortalité hospitalière › Neutrophil to lymphocyte ratio and mortality...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Neutrophil to lymphocyte ratio and mortality...
questionsmedicales.fr › Systèmes sanguin et immunitaire › Système immunitaire › Leucocytes › Agranulocytes › Lymphocytes › Neutrophil to lymphocyte ratio and mortality...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Neutrophil to lymphocyte ratio and mortality...
questionsmedicales.fr › Systèmes sanguin et immunitaire › Système immunitaire › Phagocytes › Granulocytes neutrophiles › Neutrophil to lymphocyte ratio and mortality...