Background
Methods
Data source
Population selection criteria
Date extraction
Statistical analysis and modeling strategy
Results
Subject characteristics
Characteristics | Platelet-to-lymphocyte ratio |
P value | ||
---|---|---|---|---|
<90 | 90–311 | ≥312 | ||
Platelet-to-lymphocyte ratio | 59.1 | 182.6 | 456.8 | <0.001 |
Clinical parameters, n (%) | 1708 | 6699 | 2454 | |
Age, years | 62.3 (15.9) | 65.4 (15.9) | 65.7 (15.5) | <0.001 |
Sex, n (%) | <0.001 | |||
Male | 992 (58.1) | 3679 (54.9) | 1260 (51.3) | |
Female | 716 (41.9) | 3018 (45.1) | 1194 (48.7) | |
Ethnicity, n (%) | <0.001 | |||
White | 1095 (64.10) | 4636 (69.2) | 1833 (74.7) | |
Black | 203 (11.9) | 805 (12.0) | 208 (8.5) | |
Other | 410 (24.0) | 1256 (18.8) | 413 (16.8) | |
SBP, mmHg | 120.6 (26.4) | 123.3 (26.3) | 121.9 (26.0) | <0.001 |
DBP, mmHg | 61.5 (18.6) | 62.2 (18.1) | 61.1 (17.3) | 0.021 |
Heart rate, beats/minute | 89.9 (20.9) | 88.6 (19.9) | 91.3 (20.0) | <0.001 |
Vasopressin use, n (%) | <0.001 | |||
Yes | 844 (49.4) | 2728 (40.7) | 1047 (42.7) | |
No | 864 (50.6) | 3969 (59.3) | 1407 (57.3) | |
Ventilator use, n (%) | <0.001 | |||
Yes | 1063 (62.2) | 3528 (52.7) | 1316 (53.6) | |
No | 645 (37.8) | 3169 (47.3) | 1138 (6.4) | |
Comorbidities | ||||
Cardiac arrhythmias, n (%) | <0.001 | |||
Yes | 375 (22.0) | 1944 (29.0) | 696 (28.4) | |
No | 1333 (78.0) | 4753 (71.0) | 1758 (71.6) | |
Valvular disease, n (%) | 0.051 | |||
Yes | 177 (15.7) | 740 (11.0) | 228 (9.3) | |
No | 1531 (89.6) | 5957 (89.0) | 2226 (90.7) | |
Pulmonary circulation, n (%) | 0.599 | |||
Yes | 97 (5.7) | 415 (6.2) | 158 (6.4) | |
No | 1611 (94.3) | 6282 (93.8) | 2296 (93.6) | |
Chronic pulmonary disease, n (%) | <0.001 | |||
Yes | 255 (14.9) | 1343 (20.1) | 558 (22.7) | |
No | 1453 (85.1) | 5354 (79.9) | 1896 (77.3) | |
Liver disease, n (%) | <0.001 | |||
Yes | 300 (17.6) | 492 (7.3) | 108 (4.4) | |
No | 1408 (82.4) | 6205 (92.7) | 2346 (95.6) | |
Lymphoma, n (%) | <0.001 | |||
Yes | 59 (3.5) | 123 (1.8) | 49 (2.0) | |
No | 1649 (96.5) | 6574 (98.2) | 2405 (98.0) | |
Metastatic cancer, n (%) | <0.001 | |||
Yes | 62 (3.6) | 280 (4.2) | 203 (8.3) | |
No | 1646 (96.4) | 6417 (95.8) | 2251 (91.7) | |
Solid tumor, n (%) | <0.001 | |||
Yes | 93 (5.4) | 411 (6.1) | 248 (10.1) | |
No | 1615 (94.6) | 6286 (93.9) | 2206 (89.9) | |
Deficiency anemias, n (%) | 0.046 | |||
Yes | 246 (14.4) | 1014 (15.1) | 416 (17.0) | |
No | 1462 (85.6) | 5683 (84.9) | 2038 (83.0) | |
Laboratory parameters | ||||
PO2, mmHg | 118.0 (74.0–279.0) | 113.0 (75.0–237.0) | 107.0 (72.3–201.0) | <0.001 |
PCO2, mmHg | 39.0 (34.0–46.0) | 40.0 (34.0–47.0) | 40.0 (34.0–47.0) | 0.036 |
Serum potassium, mmol/L | 4.32 (0.89) | 4.39 (0.91) | 4.44 (0.95) | <0.001 |
BUN, mg/dl | 30.0 (20.0–47.0) | 31.0 (21.0–49.0) | 33.0 (21.0–52.0) | <0.001 |
Serum bicarbonate, mmol/L | 23.0 (19.0–26.0) | 24.0 (20.0–27.0) | 23.0 (20.0–27.0) | <0.001 |
Serum pH | 7.31 (0.14) | 7.32 (0.12) | 7.32 (0.12) | <0.001 |
White blood cell count, 109/L | 11.0 (7.4–16.5) | 10.6 (7.6–15.1) | 11.8 (8.1–16.5) | <0.001 |
Neutrophil count, n (%) | 65.9 (18.2) | 77.6 (11.4) | 83.5 (12.9) | <0.001 |
Lymphocyte count, n (%) | 19.0 (12.0–28.0) | 12.0 (8.0–17.7) | 5.9 (3.8– 8.8) | <0.001 |
Platelet count, 109/L | 122.0 (67.0–182.) | 220.0 (164.0–287.0) | 285.0 (206.0–383.8) | <0.001 |
Scoring systems | ||||
GCS | 14.0 (6.0–15.0) | 15.0 (8.0–15.0) | 15.0(9.0–15.0) | <0.001 |
SOFA | 7.0 (5.0–10.0) | 5.0 (3.0– 8.0) | 5.0 (3.0– 8.0) | <0.001 |
Renal function | ||||
Serum creatinine, mg/dl | 1.50 (1.10–2.40) | 1.60 (1.20–2.40) | 1.60 (1.20–2.50) | 0.340 |
Urine output, ml/24 h | 1050 (372–2311) | 1050 (395–2325) | 900 (345–2095) | 0.046 |
eGFR, ml/min/1.73 m2
| 0.88 (0.76–0.94) | 0.87 (0.77–0.95) | 0.84 (0.76–0.94) | <0.001 |
eGFR change | 2.02 (1.17–4.27) | 1.15 (1.86–3.76) | 2.03 (1.25–4.16) | <0.001 |
KDIGO stage, n (%) | 0.084 | |||
Stage 1 | 1081 (63.4) | 4467(66.7) | 1589 (64.8) | |
Stage 2 | 407 (23.9) | 1456 (21.8) | 573 (23.3) | |
Stage 3 | 218 (12.8) | 776 (11.6) | 292 (11.9) | |
Renal replacement therapy | 0.008 | |||
Yes | 71 (4.2) | 189 (2.8) | 66 (2.7) | |
No | 1635 (95.8) | 6510 (97.2) | 2388 (97.3) |
Association between platelet-to-lymphocyte ratio and 30-day and 90-day outcomes
Platelet-to-lymphocyte ratio | No. of patients/deaths | Model 1 | Model 2 | ||
---|---|---|---|---|---|
HR (95% CIs) |
P value | HR (95% CIs) |
P value | ||
90-Day all-cause mortality | |||||
Fitted groups | |||||
< 90 | 1708/573 | 1.48 (1.34–1.62) | <0.001 | 1.25 (1.12–1.39) | <0.001 |
90–311 | 6697/1745 | 1.00 | 1.00 | ||
≥ 312 | 2454/794 | 1.29 (1.19–1.40) | <0.001 | 1.19 (1.08–1.31) | <0.001 |
Quintiles | |||||
< 101.1 | 2172/694 | 1.43 (1.27–1.60) | <0.001 | 1.27 (1.11–1.44) | <0.001 |
101.2–155.6 | 2172/545 | 1.00 | 1.00 | ||
155.7–220.2 | 2173/571 | 1.04 (0.93–1.18) | 0.477 | 1.12 (0.98–1.28) | 0.093 |
220.3–330.1 | 2171/602 | 1.09 (0.97–1.23) | 0.152 | 1.07 (0.94–1.22) | 0.296 |
≥ 330.2 | 2171/700 | 1.33 (1.19–1.49) | <0.001 | 1.23 (1.08–1.40) | 0.002 |
30-Day all-cause mortality | |||||
Fitted groups | |||||
< 90 | 1708/448 | 1.56 (1.40–1.74) | <0.001 | 1.29 (1.14–1.46) | <0.001 |
90–311 | 6697/1273 | 1.00 | 1.00 | ||
≥ 312 | 2454/556 | 1.21 (1.09–1.34) | <0.001 | 1.12 (1.00–1.25) | 0.047 |
P
trend
| |||||
Quintiles | |||||
< 101.1 | 2172/532 | 1.39 (1.22–1.58) | <0.001 | 1.30 (1.12–1.50) | 0.001 |
101.2–155.6 | 2172/406 | 1.00 | |||
155.7–220.2 | 2173/423 | 1.05 (0.91–1.20) | 0.516 | 1.12 (0.96–1.31) | 0.141 |
220.3–330.1 | 2171/432 | 1.06 (0.93–1.22) | 0.388 | 1.04 (0.89–1.21) | 0.649 |
≥ 330.2 | 2171/484 | 1.22 (1.07–1.39) | 0.003 | 1.14 (0.98–1.32) | 0.088 |
Subgroup analyses
No. of patients/deaths | Platelet-to-lymphocyte ratio | ||||
---|---|---|---|---|---|
<90 | 90–311 | ≥312 |
P for interaction | ||
AKI stage | 0.301 | ||||
Stage 1 | 7137/1740 | 1.23 (1.05–1.43)a
| 1.00 | 1.22 (1.08–1.38)a
| |
Stage 2 | 2436/1474 | 1.23 (1.02–1.50)b
| 1.00 | 1.09 (0.92–1.30) | |
Stage 3 | 1286/876 | 1.38 (1.04–1.82) | 1.00 | 1.30 (0.99–1.72) | |
Renal replacement therapy | 0.906 | ||||
Yes | 326/177 | 1.45 (0.97–2.17) | 1.00 | 1.31 (0.86–2.01) | |
No | 10,533/2935 | 1.24 (1.11–1.39)c
| 1.00 | 1.17 (1.06–1.29)a
| |
Age, years | <0.001 | ||||
< 65 | 4686/1000 | 1.37 (1.16–1.62)c
| 1.00 | 1.06 (0.88–1.27) | |
≥ 65 | 6035/2054 | 1.09 (0.94–1.27) | 1.00 | 1.25 (1.12–1.40)c
| |
Sex | 0.386 | ||||
Male | 5931/1741 | 1.22 (1.06–1.41)a
| 1.00 | 1.24 (1.09–1.41)c
| |
Female | 4928/1371 | 1.26 (1.06–1.49)a
| 1.00 | 1.13 (0.98–1.31) | |
Ethnicity | 0.409 | ||||
White | 7564/2134 | 1.25 (1.09–1.44)c
| 1.00 | 1.19 (1.06–1.33)a
| |
Black | 1216/254 | 1.24 (0.84–1.81) | 1.00 | 1.33 (0.92–1.93) | |
Other | 2079/724 | 1.21 (0.98–1.49) | 1.00 | 1.11 (0.90–1.36) | |
PO2, mmHg | 0.310 | ||||
< 167.3 | 6433/2108 | 1.29 (1.14–1.47)c
| 1.00 | 1.21 (1.08–1.35)a
| |
≥1 67.3 | 3502/870 | 1.16 (0.95–1.42) | 1.00 | 1.21 (1.00–1.47) | |
GCS score | 0.938 | ||||
< 11.4 | 4101/1387 | 1.25 (1.07–1.46)a
| 1.00 | 1.21 (1.05–1.39) | |
≥ 11.4 | 6499/1663 | 1.24 (1.06–1.45)a
| 1.00 | 1.18 (1.04–1.35)b
| |
Heart rate, beats/min | 0.001 | ||||
< 89.4 | 5811/1503 | 1.08 (0.92–1.28) | 1.00 | 1.29 (1.12–1.48)c
| |
≥ 89.4 | 4880/1575 | 1.39 (1.20–1.61)c
| 1.00 | 1.10 (0.96–1.26) | |
SBP, mmHg | 0.187 | ||||
< 122.6 | 5596/1885 | 1.28 (1.12–1.46)c
| 1.00 | 1.15 (1.02–1.30)b
| |
≥ 122.6 | 4800/1070 | 1.18 (0.97–1.43) | 1.00 | 1.26 (1.07–1.47)a
| |
Potassium, mmol/L | 0.633 | ||||
< 4.39 | 6158/1667 | 1.24 (1.07–1.44)a
| 1.00 | 1.19 (1.04–1.36)a
| |
≥ 4.39 | 4692/1443 | 1.24 (1.05–1.47)b
| 1.00 | 1.22 (1.06–1.40)a
| |
Creatinine, mg/dl | 0.816 | ||||
< 2.28 | 7809/2128 | 1.29 (1.13–1.47)c
| 1.00 | 1.21 (1.08–1.35)a
| |
≥ 2.28 | 3048/982 | 1.17 (0.96–1.44) | 1.00 | 1.15 (0.97–1.37) | |
Urine output, ml/24 h | 0.083 | ||||
< 1807 | 7057/2309 | 1.28 (1.13–1.45)c
| 1.00 | 1.13 (1.02–1.26)b
| |
≥ 1807 | 3300/641 | 1.17 (0.92–1.47) | 1.00 | 1.38 (1.12–1.69)a
| |
BUN, mg/dl | 0.615 | ||||
< 39.2 | 6887/1737 | 1.30 (1.13–1.50)c
| 1.00 | 1.23 (1.08–1.40)a
| |
≥ 39.2 | 3972/1375 | 1.19 (1.00–1.41) | 1.00 | 1.17 (1.01–1.35)b
| |
Vasopressin use | 0.549 | ||||
Yes | 4619/1784 | 1.29 (1.13–1.48)c
| 1.00 | 1.24 (1.09–1.40)a
| |
No | 6240/1328 | 1.17 (0.96–1.42) | 1.00 | 1.11 (0.95–1.29) | |
Ventilator use | 0.216 | ||||
Yes | 5907/2098 | 1.26 (1.12–1.43)c
| 1.00 | 1.17 (1.05–1.31)a
| |
No | 4952/1014 | 1.21 (0.95–1.54) | 1.00 | 1.21 (1.01–1.45)b
| |
Cardiac arrhythmias | 0.671 | ||||
Yes | 3015/1040 | 1.13 (0.91–1.39) | 1.00 | 1.19 (1.02–1.40)b
| |
No | 7844/2072 | 1.29 (1.13–1.47)c
| 1.00 | 1.19 (1.06–1.34)a
| |
Valvular disease | 0.986 | ||||
Yes | 1145/339 | 0.75 (0.51–1.10) | 1.00 | 1.37 (1.01–1.87)b
| |
No | 9714/2773 | 1.31 (1.17–1.47)c
| 1.00 | 1.18 (1.07–1.31)a
| |
Pulmonary circulation | 0.320 | ||||
Yes | 670/199 | 1.20 (0.76–1.89) | 1.00 | 1.12 (0.76–1.63) | |
No | 10,189/2913 | 1.34 (1.11–1.39)c
| 1.00 | 1.18 (1.07–1.31)a
| |
Chronic pulmonary disease | 0.289 | ||||
Yes | 2156/638 | 0.97 (0.72–1.29) | 1.00 | 1.14 (0.94–1.38) | |
No | 8703/2474 | 1.29 (1.15–1.46)c
| 1.00 | 1.21 (1.08–1.34)a
| |
Liver disease | 0.919 | ||||
Yes | 900/410 | 1.13 (0.89–1.45) | 1.00 | 1.08 (0.78–1.50) | |
No | 9959/2702 | 1.26 (1.12–1.42)c
| 1.00 | 1.21 (1.09–1.33)c
| |
Lymphoma | 0.101 | ||||
Yes | 231/102 | 1.66 (0.94–2.93) | 1.00 | 1.79 (0.97–3.30) | |
No | 10,628/3010 | 1.23 (1.10–1.37)c
| 1.00 | 1.18 (1.07–1.30)a
| |
Metastatic cancer | 0.901 | ||||
Yes | 545/317 | 0.97 (0.63–1.49) | 1.00 | 1.11 (0.84–1.45) | |
No | 10,314/2795 | 1.26 (1.12–1.41)c
| 1.00 | 1.15 (1.04–1.27)a
| |
Solid tumor | 0.605 | ||||
Yes | 752/333 | 1.22 (0.82–1.81) | 1.00 | 1.21 (0.91–1.60) | |
No | 10,107/2779 | 1.24 (1.10–1.38)c
| 1.00 | 1.18 (1.07–1.31)a
| |
Deficiency anemias | 0.852 | ||||
Yes | 1676/378 | 1.15 (0.91–1.46) | 1.00 | 1.12 (0.77–1.53) | |
No | 9183/2734 | 1.25 (1.10–1.39) | 1.00 | 1.20 (1.07–1.33) | |
Cardiac surgery | 0.207 | ||||
Yes | 1864/635 | 1.16 (0.92–1.45) | 1.00 | 1.24 (1.01–1.52)b
| |
No | 8995/2477 | 1.30 (1.14–1.47)c
| 1.00 | 1.16 (1.04–1.29)a
|