| Chapter 1 Application of the initial emergency neutrophil to lymphocyte ratio(NLR)in assessing the severity of early spinal cord injuryObjectives: To investigate the function of the initial peripheral blood neutrophil to lymphocyte ratio(NLR)in the Emergency Department in the early assessment of injury severity in patients withspinal cord injury(SCI).Methods:A total of 62 patients with SCI admitted to the Emergency Department of Southwest Hospital of Army Medical University then transferred to the Department of Rehabilitation Medicine from June 2010 to January 2021 were analyzed retrospectively.According to the initial grade of ASIA Impairment Scale after the injury which is used as the judgment basis for early injury severity of SCI patients,the included patients were dichotomized into either the complete motor function injury group(ASIA Impairment Scale A or B,n=35)or the incomplete motor function injury group(ASIA Impairment Scale C or D,n=27).The clinical data and laboratory data of the two groups were collected,and NLR was calculated according to the initial neutrophil count and lymphocyte count in the Emergency Department,the univariate analysis was used to compare the data differences between the two groups,the multivariate Logistic regression was used to analyze the possible risk factors of complete motor function injury,and the evaluation ability of each index was evaluated by the area under the receiver operating characteristic(ROC)curve(AUC).Results:The initial NLR in the Emergency Department in the complete motor function injury group was significantly higher than that in the incomplete motor function injury group(P<0.05),and the lymphocyte count was significantly lower in the complete motor function injury group than that in the incomplete motor function injury group(P<0.01).The results of multivariate Logistic regression analysis showed that the increase of the initial lymphocyte count in the Emergency Department was an independent protective factor for complete motor function injury(OR=0.211,95%CI:0.051~0.878,P<0.05).The AUC of NLR was 0.726(95%CI:0.598~0.854,P<0.05).When the cut-off value was 9.711,the maximum Youden index was 0.398,its sensitivity was 65.71% and specificity was 74.07%.The AUC of lymphocyte count was 0.740(95%CI:0.610~0.870,P<0.05).When the cut-off value was 1.220,the maximum Youden index was 0.461,the sensitivity was 94.29% and specificity was 51.85%.The AUC of the combination of NLR and lymphocyte count was 0.751(95%CI: 0.625~0.878,P<0.05).Conclusions: As simple,cheap and easily available data,the initial NLR in the Emergency Department may have a certain value in evaluating the severity of early SCI.Chapter 2 Application of neutrophil to lymphocyte ratio(NLR)at different time points in predicting 3-month outcome of spinal cord injuryObjectives: To investigate the value of peripheral blood NLR at three different time points,as within 72 hours postinjury,postoperation,and in the stable period after operation respectively,in predicting 3-month outcome of SCI.Methods: A total of 94 patients with SCI who underwent surgery in the Emergency Department or the Orthopedics Department of Southwest Hospital of Army Medical University then transferred to the Department of Rehabilitation Medicine from June 2010 to December 2021 were analyzed retrospectively.NLR was calculated according to the neutrophil count and lymphocyte count at different time points postinjury.The mixed linear model was used to analyze the changing trend of NLR at different time points.The included 65 patients which with both complete blood routine data(within 72 hours postinjury,postoperation,and in the stable period after operation)and exact grade of ASIA Impairment Scale at 3-month after SCI were dichotomized into either the complete motor function injury group(ASIA Impairment Scale A or B,n=31)or the incomplete motor function injury group(ASIA Impairment Scale C or D,n=34).The univariate analysis was used to compare the data differences between the two groups,the multivariate Logistic regression was used to analyze the possible risk factors of 3-month outcome of SCI,and the predicting ability of each index was evaluated by the area under the ROC curve.Results:The levels of NLR were significantly different between the 3 time points after SCI as within 72 hours postinjury,postoperation,and in stable period after operation(F=20.15,P<0.001).The NLR within 72 hours postinjury,postoperation,and in stable period after operation in the complete motor function injury group were significantly higher than that in the incomplete motor function injury group(P<0.05),and the lymphocyte count within 72 hours postinjury and in stable period after operation were significantly lower in the complete motor function injury group than that in the incomplete motor function injury group(P<0.05).The results of multivariate Logistic regression analysis showed that the higher NLR level in stable period after operation was an independent risk factor for complete motor function injury at 3-month after SCI(OR=5.167,95%CI:1.667~16.018,P<0.05),and the higher lymphocyte count level within 72 hours postinjury was an independent protective factor for complete motor function injury(OR=0.194,95%CI:0.051~0.731,P<0.05).The AUC of NLR in stable period after operation was 0.736(95%CI:0.612~0.838,P<0.001).When the cut-off value was 6.03,the maximum Youden index was 0.413,its sensitivity was 67.74% and specificity was 73.53%.The AUC of the combination of NLR in stable period after operation and lymphocyte count within 72 hours postinjury was 0.771(95%CI: 0.650~0.866,P<0.05).Conclusions:The levels of NLR were significantly fluctuating at 3 time points after SCI as within 72 hours postinjury,postoperation,and in stable period after operation.The NLR in stable period after operation may have a certain value in predicting 3-month outcome of SCI. |
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