Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio as predictors of refractory anaphylaxis

IF 3.9 2区医学 Q2 ALLERGY World Allergy Organization Journal Pub Date : 2024-08-01 DOI:10.1016/j.waojou.2024.100944

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引用次数: 0

Abstract

Background

Refractory anaphylaxis poses an ongoing, lethal hypersensitivity response that unpredictably involves multiple organs despite appropriate intramuscular (IM) adrenaline injections. Studies on the association of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) concerning anaphylactic severity have yet to be carried out. The study aimed to evaluate the association between blood PLR and NLR levels and refractory anaphylaxis.

Methods

We carried out a retrospective cross-sectional study in which medical records of patients with anaphylaxis who sought urgent care at the Emergency Department (ED) of Tertiary Hospital in Hanoi, Vietnam, were evaluated. Based on the United Kingdom Resuscitation Council guidelines in 2021, patients were classified as refractory anaphylaxis if they needed more than two appropriate doses of intramuscular adrenaline for anaphylactic symptoms resolution. Clinical data and laboratory results were obtained in the medical records. Logistic regression analysis determined the association between contributing factors and refractory anaphylaxis.

Results

One-hundred eighteen adults (age 51.80 ± 18.25 years) were analyzed, including 38 refractory anaphylaxis patients (32.2%). Refractory anaphylaxis patients exhibited notably elevated platelet-to-lymphocyte ratio (PLR) (P = 0.006) and increased neutrophil-to-lymphocyte ratio (NLR) (P < 0.001) in comparison to non-refractory anaphylaxis patients. Receiver operating characteristic curve (ROC) analysis demonstrated an optimal PLR cutoff value of 129.5 (area under the ROC curve [AUC] 0.658, sensitivity 73.68%, specificity 61.25%, P = 0.004) and an optimal NLR cutoff value of 4 (AUC 0.736, sensitivity 65.79%, specificity 73.75%, P < 0.001) for refractory anaphylaxis. Multivariate logistic regression analysis revealed a PLR≥129.5 (OR = 4.83, 95% CI: 1.87–12.48) and an NLR≥4 (OR = 4.60, 95% CI: 1.86–11.41) were independently associated with refractory anaphylaxis.

Conclusion

Elevated PLR and NLR serve as independent indicators significantly associated with refractory anaphylaxis.

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预测难治性过敏性休克的血小板与淋巴细胞比率和中性粒细胞与淋巴细胞比率

背景难治性过敏性休克是一种持续、致命的超敏反应，尽管已适当注射了肾上腺素，但仍会不可预测地累及多个器官。关于血小板与淋巴细胞比值（PLR）和中性粒细胞与淋巴细胞比值（NLR）与过敏性休克严重程度的关联研究尚未开展。本研究旨在评估血液中 PLR 和 NLR 水平与难治性过敏性休克之间的关系。方法我们开展了一项回顾性横断面研究，评估了在越南河内市三级医院急诊科（ED）就诊的过敏性休克患者的医疗记录。根据英国复苏委员会 2021 年的指导方针，如果患者需要超过两剂适当的肌肉注射肾上腺素才能缓解过敏性休克症状，则被归类为难治性过敏性休克。临床数据和实验室结果均来自医疗记录。结果分析了 118 名成年人（年龄 51.80 ± 18.25 岁），其中包括 38 名难治性过敏性休克患者（32.2%）。与非难治性过敏性休克患者相比，难治性过敏性休克患者的血小板与淋巴细胞比值（PLR）明显升高（P = 0.006），中性粒细胞与淋巴细胞比值（NLR）明显升高（P < 0.001）。接收者操作特征曲线（ROC）分析表明，难治性过敏性休克的最佳 PLR 临界值为 129.5（ROC 曲线下面积 [AUC] 0.658，敏感性 73.68%，特异性 61.25%，P = 0.004），最佳 NLR 临界值为 4（AUC 0.736，敏感性 65.79%，特异性 73.75%，P <0.001）。多变量逻辑回归分析显示，PLR≥129.5（OR = 4.83，95% CI：1.87-12.48）和 NLR≥4 （OR = 4.60，95% CI：1.86-11.41）与难治性过敏性休克独立相关。

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来源期刊

World Allergy Organization Journal Immunology and Microbiology-Immunology

CiteScore

9.10

自引率

5.90%

发文量

审稿时长

9 weeks

期刊介绍： The official pubication of the World Allergy Organization, the World Allergy Organization Journal (WAOjournal) publishes original mechanistic, translational, and clinical research on the topics of allergy, asthma, anaphylaxis, and clincial immunology, as well as reviews, guidelines, and position papers that contribute to the improvement of patient care. WAOjournal publishes research on the growth of allergy prevalence within the scope of single countries, country comparisons, and practical global issues and regulations, or threats to the allergy specialty. The Journal invites the submissions of all authors interested in publishing on current global problems in allergy, asthma, anaphylaxis, and immunology. Of particular interest are the immunological consequences of climate change and the subsequent systematic transformations in food habits and their consequences for the allergy/immunology discipline.