Application Of Monocyte Count And HDL Ratio In Severity Of Acute Pulmonary Embolism And Prediction Of In-hospital Death

OBJECTIVE: Recent studies have shown that inflammatory markers such as white blood cell count are associated with pulmonary embolism severity and mortality.High density lipoprotein(HDL)is a protective factor for pulmonary embolism.This article was to explore relationship between monocyte count / HDL ratio(Monocyte/HDL ratio,MHR)and severity of pulmonary embolism and in-hospital mortality.METHODS: A retrospective cohort study was conducted to enroll 286 cases of pulmonary embolism admitted to the Fujian Provincial Hospital from May 2012 to March 2019.Collected basic information such as age,underlying disease,white blood cell count,monocyte count,HDL,troponin,D-dimer and other laboratory tests,and calculate MHR.The MHR levels between different severity of illness and survival in the hospital were analyzed.RESULTS: The patients were divided into survival group(n=271)and death group(n=15)according to the living conditions in the hospital.There was no significant difference in the basic conditions of age,hypertension,diabetes and cerebral infarction between the two groups(p>0.05).There were statistical differences in white blood cell count,monocyte count,albumin,HDL,and MHR(p<0.05).The above indicators used the receiver’s work curve to predict in-hospital mortality.The largest area under the curve was white blood cell count and MHR,which were 0.798 and0.675,respectively.According to MHR cutoff value of 0.37,MHR>0.37 group and MHR≤0.37 group,D-dimer and troponin levels were significantly higher in patients with MHR>0.37 than in MHR≤0.37,[2.59(0.72,5.41)VS4.08(1.91,7.54)]、[0.02(0.00,0.02)vs0.02(0.00,0.09)] respectively,the difference was statistically significant(P <0.05).According to the 2019 European Association of Cardiac and Respiratory Association guidelines for the diagnosis and management of acute pulmonary embolism,risk stratification is divided into high-risk,intermediate-high risk,intermediate-low risk and low risk PE patients.The MHR levels of patients in the intermediate-high risk,intermediate-low risk,and high risk groups were significantly higher than those in the low risk group,and the differences were statistically significant(P values were 0.003,0.022,and 0.004,respectively).Using logistic regression analysis,MHR,white blood cell count and creatinine were found to be elevated,and HDL was an independent risk factor for in-hospital death in patients with pulmonary embolism.Conclusion: This study found that elevated MHR,white blood cell count,D-dimer,creatinine,and decreased HDL were independent risk factors for in-hospital death.MHR levels were higher in patients with moderate to high risk than in low-risk patients.