ABSTRACT
BACKGROUND: Neutrophil-lymphocyte ratio (NLR) has shown a good prognostic value in many different type of malignancies. The purpose of this study was to investigate the relationship between NLR and the outcome of critically ill patients with cancer. METHODS: We performed a single-institution, retrospective study of 1317 adult critically ill patients with cancer and determined the optimal cut-off for NLR by X-tile software. Propensity score matching (PSM) and inverse probabilities of treatment weighting (IPTW) were performed to control confounders. Cox proportional hazards model was used to evaluate the relationship between NLR and 28-day, 6-month and 1-year all-cause mortality. Kaplan-Meier method, subgroup analysis, and receiver operating characteristics (ROC) analysis were applied to assess the prognostic value of NLR. RESULTS: The cut-off value for NLR was 17.6. Cox proportional hazards model demonstrated that high NLR (> 17.6) was independently associated with 28-day, 6-month and 1-year all-cause mortality with hazard ratio (HR) of 1.58 (1.29, 1.94), 1.51 (1.28, 1.77) and 1.45 (1.25, 1.69), respectively. The results were consistent with survival analyses (p < 0.001, log-rank test). The ROC analyses showed that the discrimination abilities of NLR were better than other blood-based biomarkers. CONCLUSION: NLR is a promising prognostic indicator of survival in unselected critical ill patients with cancer.
Subject(s)
Lymphocytes/cytology , Neoplasms/mortality , Neutrophils/cytology , Aged , Critical Illness/mortality , Female , Humans , Kaplan-Meier Estimate , Lymphocyte Count , Male , Prognosis , Propensity Score , Proportional Hazards Models , ROC Curve , Retrospective Studies , Survival Analysis , Time FactorsABSTRACT
Distal radius fracture is a common wound. It is reduced by surgery under anesthesia. Emergence agitation can often occur after anesthesia. It is associated with increased morbidity and hospital costs. However, there have been almost no reports in the medical literature on the occurrence of emergence agitation in adults. This study aimed to compare emergence agitation between isoflurane and propofol anesthesia in adults after closed reduction of distal radius fracture. Forty adults (ASA I-II) undergoing closed reduction of distal radius fracture were randomly assigned to either the isoflurane or propofol group and anesthesia was maintained with isoflurane or propofol. The bispectral index was monitored and maintained within 40-60. After reduction of fracture and fixation with plaster, patients were transported to the post-anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). AFPS score of 3 or 4 was considered to be emergence agitation. Pain scores were measured by the numeric rating scale (NRS) on arrival and at peak value at PACU. Eight (40.0%) patients in the isoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation (P = 0.031). There was no correlation between peak NRS and AFPS. Propofol may decrease the incidence of emergence agitation compared to isoflurane in adults undergoing closed reduction of distal radius fracture.