Application Of Blood Cell Parameters In Prognosis Of Patients With Acute Pulmonary Embolism

Objective:To explore the prognistic value of the neutrophil lymphocyte ratio(NLR)?platelet-lymphocyte ratio(PLR)?platelet distribution width(PDW)?Red Cell Distribution Width(RDW)and so on in hemodynamic stabilly patients with acute pulmonary embolism.Those blood cell parameters will be compared with NT-proNBP?cTNT-hs in the guidelines to evaluate their relevance and whether them could be used as prognostic indicators in those patients above.Methods:A total of 207 APE patients with hemodynamic stability from the Second Affiliated Hospital of Kuming Medcal University were enrolled.At first,the pationts who were in hospital between April 2015 and June 2016 were screened,135 patients were been divided into adverse clinical events(n=24)and non-adverse clinical events(n=111)groups to explore their statistical differences.Second,the pationts who were in hospital between August 2015 and February 2016 were screened,72 patients were been divided into different groups according to the NLR cut off value.Observed the number of adverse clinical events in each group after standard treatment during 30 days to verificate the value and superiority of blood cell parameters above for predicting clinical adverse events.Results:l.There were significant differences in blood cell parameters as WBC,N,NLR and PLR between the clinical adverse events group and the non-clinical adverse events group,but there was no significant difference between PDW and RDW in the first phase of 135 patients.The area under the curve(AUC)of WBC,N,NLR and PLR:0.78?0.81?0.87 and 0.60;P-value of WBC,N,NLR were below 0.01 and P-value of PLR was 0.11.The sensitivity,specificity,positive predictive value and negative predictive value of WBC,N,NLR,Pro-BNP and cTNT-hs were 83.3%,75.7%,42.5%,95.5%and 83.3%95%,21.8%,90.8%,70.8%,62.2%,28.8%and 90.8%respectively.The cut off value of NLR to predict clinical adverse events was 4.87.2.There were significant differences in blood cell parameters WBC,N and NLR between NLR ?4.87 group(n = 22 cases)and NLR<4.87group(n ? 50 cases)in the second phase of 72 patients.The difference was not statistically significant of other blood cell parameters.NLR is the best in the blood cell parameters.Having NLR above 4.87 is found to be associated with 22.73 times higher clinical adverse events incidence rate.The area under the curve(AUC)of NLR,cTNT-hs,Pro-BNP:0.852?0.781and0.821(P<0.05),The sensitivity,specificity,positive predictive value,negative predictive value and RR:90.9%?80.3%?45.5%?98%?22.73;72.7%?74%?30%?90.4%?3.12;82%?87%?40.9%?96%?25.00 respectively.The sensitivity,specificity,positive predictive value and negative predictive value of NLR combined with Pro-BNP:100%?97%?85.7%?100%,P=0.00.Conclusion:1.NLR,Pro-BNP and cTNT-hs have a certain value in predicting the occurrence of clinical adverse events in patients with pulmonary embolism.2.NLR can be used as an independent predictor of clinical adverse events in patients with pulmonary embolism,which can be used for clinical classification of pulmonary embolism.3.NLR combined with Pro-BNP predictive value is more significant.