Predictive value of RAR,NLR,and PLR for prognosis of patients with severe ARDS supported by VV-ECMO
Li Yiheng
Song Doudou
Wang Wentao
Yan Lvyin
Qi Shaoyan
Abstract：Objective To investigate the predictive value of Red blood cell distribution width to albumin ratio(RAR)and neutrophil-to-lymphocyte ratio(NLR)for28 d of death in patients with severe acute respiratory distress syn-drome(ARDS)supported by veno-venous extracorporeal membrane pulmonary oxygenation(W-ECMO).Methods Clinical data of W-ECMO-supported ARDS patients admitted to the intensive care unit(ICU)of the Second Affiliated Hospital of Zhengzhou University from August 2019 to February2024 were retrospectively selected.The time of patients'initiation of W-ECMO therapy was used as the starting point of the study,and they were divided into 49 cases in the survival group and 112 cases in the death group based on survival after 28 d of treatment.Pearson correlation coefficients were used to an-alyze the correlation between RAR,NLR,and PLR and APACHE Ⅱ score and SOFA score;multifactorial logistic regression was used to analyze the factors influencing the prognosis of patients with severe ARDS;and subject work characteristics(ROC)curves were used to evaluate the predictive value of RAR,NLR,and PLR on the death of28-d mortality in those trea-ted with W-ECMO;Kaplan-Meier method to analyze 28 d cumulative survival of severe ARDS patients with different RAR,NLR,and PLR levels.Results RAR,NLR,and PLR were higher in the death group than in the survival group(t/P=6.802/＜0.001,4.847/＜0.001,2.936/＜0.001);RAR was positively correlated with APACHE Ⅱ scores and SOFA scores in ARDS pa-tients treated with W-ECMO(r/P=0.175/0.027,0250/0.001),and PLR was negatively correlated with APACHE Ⅱ score and SOFA score(r/P=-0.190/0.016,-0.397/＜0.001);the results of multifactorial logistic regression analysis showed that high age,APACHE Ⅱ score,SOFA score,RAR,and NLR were the main factors in the W-ECMO-treated independent risk factors for 28-d death in ARDS patients[OR(95％CI)=1.055(1.001-1.111),1.235(1.029-1.482),1.284(1.022-1.614),3.135(1.163-8.448),and 1.059(1.002-1.120)],and that ICU hospitalization prolonged duration was independent protective factor[OR(95％CI)=0.758(0.664-0.866)];The area under the curve(AUC)of RAR,NLR,PLR,and the combination of the three for predicting 28 d death in W-ECMO-treated patients was 0.774,0.716,0.584,and 0.848,respectively,and the combination of the three was superior to their respective individual predictions(Z/P=2.581/0.010,3.947/＜0.001,5.487/＜0.001);Kaplan-Meier survival analysis showed that 28 d cumulative survival was lower for those with RAR ≥ 0.49 than for those with RAR＜0.49(8.33％vs.4831％,x2=30.050,P＜0.001);and 28 d cumulative survival was higher for those with NLR≥24.64 was lower than those with NLR＜24.64(10.61％vs.4421％,x2=20.772,P＜0.001);those with PLR ≥401.31 had lower 28 d cumulative survival than those with PLR＜40131(12.50％vs.36.36％,x2=8.086,P=0.004).Conclusion RAR,NLR,and PLR all have a certain predictive value for the prognosis of patients with ARDS supported by W-ECMO,and the combined diagnostic predictive value of the three is even higher.
Keywords：Acute respiratory distress syndromeRed blood cell distribution width to albumin ratioNeutrophil to lymphocyte ratioPlatelet-to-lymphocyte ratioVeno-venous extracorporeal membrane oxygenationMortalityPrognosis
Publication Date：2025-04-18
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 456-462 )