| Objective:To explore and verify the predictive value of peripheral blood cell analysis and IABP-SHOCK Ⅱ score for in-hospital death of patients with cardiogenic shock（CS）after acute myocardial infarction（AMI）.Methods:Patients with CS secondary to AMI in the cardiovascular intensive care unit（CICU）of the First Bethune Hospital of Jilin University from January 1,2014 to September 30,2019 were enrolled retrospectively.177 patients were selected according to the inclusion and exclusion criteria.The subjects were divided into death and survival groups according to whether death occurred in the hospital.Through medical record query systems,general clinical data of patients were collected: age,sex,state of consciousness,hypertension history,diabetes history,stroke history,myocardial infarction history,coronary artery bypass grafting history,and so on.The latest clinical lab indexes,cardiac color doppler ultrasound results,and thrombolysis in myocardial infarction（TIMI）blood flow grades after percutaneous coronary intervention（PCI）were recorded at the time of CS.After collecting the data,glomerular filtration rate（e GFR）,neutrophil and lymphocyte ratio（NLR）,monocyte and lymphocyte ratio（MLR）,platelet and lymphocyte ratio（PLR）,and IABPSHOCK Ⅱ score were calculated.1)The general clinical data,clinical lab indexes,left ventricular ejection fraction,TIMI blood flow grades,NLR,PLR,MLR,and IABPSHOCK Ⅱ score were compared between the two groups.2)The areas under the curve（AUC）were calculated according to the receiver operating characteristic curve（ROC）analysis,and the 95% confidence interval（CI）was used to evaluate the predictive value of peripheral blood cell analysis and IABP-SHOCK Ⅱ score on inhospital death of patients with CS secondary to AMI.3)The patients were divided into two groups according to the best cut-off value,and the mortality rates between the two groups were compared respectively.4)The mortality rates of each group in risk stratification were calculated to verify the differentiation of risk stratification in predicting in-hospital mortality.At the same time,the calibration degree was evaluated according to the goodness-of-fit test and calibration curve.5)Clinically relevant indicators with statistically significant differences were selected and included in multivariate binary Logistic regression analysis to screen independent predictors.6)To evaluate the predictive value of combined indicators for in-hospital death of CS patients after AMI,compare the degree of discrimination and carry out grouping verification.All the data were statistically analyzed by SPSS 26.0 software.P<0.05 was considered to be statistically significant.Results:1.According to the inclusion and exclusion criteria,177 patients with CS secondary to AMI were studied.During hospitalization,110 patients died,and 67 patients survived.There were significant differences in age,consciousness,hypertension history,stroke history,neutrophil complete count,white blood cell（WBC）complete count,NLR,PLR,lymphocyte complete count,random blood glucose,lactic acid,serum creatinine,e GFR,TIMI blood flow grades after PCI,and IABP-SHOCK Ⅱ score between the death and survival group（all P<0.05）.2.According to the analysis of ROC,the AUC of WBC,neutrophil and lymphocyte complete counts and PLR were all greater than 0.6（all P<0.05）.Still,the sensitivity and/or specificity were/was not high,among which the AUC of NLR had a great trend,which was 0.693（95%CI: 0.608-0.779,P<0.001）.The best cut-off value was 5.73 with 76.4% sensitivity and 61.2% specificity.According to the best cut-off point of NLR,patients were divided into the low NLR group and the high NLR group.26/67（38.81%）patients died in the low NLR group,and 84/110（76.36%）patients died in the high NLR group.There was a significant difference between the two groups（P<0.001）.3.The AUC of the IABP-SHOCK Ⅱ score was 0.785（95%CI: 0.718-0.853,P<0.001）.The best cut-off point of the IABP-SHOCK Ⅱ score was 4 points,with 71.8%sensitivity and 77.6% specificity.According to the IABP-SHOCK Ⅱ score of 4,the patients were divided into a high IABP-SHOCK Ⅱ score group（≥4 points）and a low IABP-SHOCK Ⅱ score group（<4 points）.71/86（82.56%）patients died in the high IABP-SHOCK Ⅱ score group,and 39/91（42.86%）patients died in the low IABPSHOCK Ⅱ score group.There was a significant difference between the two groups（P<0.001）.4.Risk stratification was conducted according to the IABP-SHOCK Ⅱ score.There were 46 patients in the low-risk group（0～2 points）,of which 12 patients died,with a mortality rate of 26.09%.There were 78 patients in the medium-risk group（3～4 points）,of which 51 patients died,with a mortality rate of 65.38%.There were53 patients in the high-risk group（5～9 points）,of which 47 patients died,with a mortality rate of 88.68%.There was a significant difference between the groups（P<0.01）.The mortality of each group was similar to that of the previous relevant study.According to the goodness-of-fit test and calibration curve,the IABP-SHOCKⅡ score could be fully calibrated,and the estimated mortality rate was close to the actual mortality rate（P>0.05）.5.According to the multivariate binary Logistic regression analysis,IABPSHOCK Ⅱ score and NLR were independent predictors of in-hospital death in CS patients after AMI（all P<0.001）.6.The AUC of the combined index of NLR and IABP-SHOCK Ⅱ score was0.842（95%CI: 0.783-0.902,P<0.001）.The Jordan index was 0.558,the sensitivity was 78.2%,and the specificity was 77.6%.The difference was statistically significant when compared with IABP-SHOCK Ⅱ score and NLR by Delong method（0.842 vs0.785,P<0.001,and 0.842 vs 0.693,P<0.001）.Compared with high IABP-SHOCK Ⅱscore and low NLR group,low IABP-SHOCK Ⅱ score and high NLR group,low IABP-SHOCK Ⅱ score and low NLR group,the in-hospital mortality rate of high IABP-SHOCK Ⅱ score and high NLR group was significantly higher,and the difference was statistically significant（all P<0.05）.Conclusions:1.NLR in peripheral blood cell analysis could be used as a predictor of inhospital mortality in CS patients after AMI;WBC,neutrophil and lymphocyte complete counts,and PLR might have a certain degree of predictive value,but the specificity and/or sensitivity are/is not high.2.IABP-SHOCK Ⅱ score is of high value in predicting in-hospital death in patients with CS after AMI.IABP-SHOCK Ⅱ score combined with NLR may further improve its predictive value. |
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