Relação Neutrófilo-Linfócito: Acrescentando um Biomarcador a uma Escala Preditiva de Pneumonia Pós-Acidente Vascular Cerebral
DOI:
https://doi.org/10.24950/rspmi.2022.01.oPalavras-chave:
Acidente Vascular Cerebral/complicações, Linfócito, Neutrófilo, PneumoniaResumo
Introdução: Avaliar a associação da relação neutrófilo-linfócito (NLR) e a incidência de pneumonia pós-acidente vascular cerebral (PSP), subtipo de acidente vascular cerebral (AVC), gravidade e prognóstico.
Material e Métodos: Foi realizado um estudo prospetivo observacional durante um período de 42 meses numa Unidade de AVC de um hospital terciário. Todos os doentes com AVC isquémico agudo (AIS) foram sequencialmente incluídos. O valor de NLR foi calculado na admissão. As características dos doentes como subtipo de AVC, gravidade e diagnóstico de PSP foram obtidos. A escala A2DS2 foi utilizada como preditor clínico de PSP.
Resultados: Foram identificados 521 doentes com AIS. A idade média foi 76,17 ± 10,16 anos, 46,9% eram homens. Verificou-se uma associação entre NLR, tipo e gravidade de AVC (p <0,01), persistindo em análise estratificada após exclusão de infeção concomitante. Doentes com NLR mais elevado apresentavam défice neurológico mais grave na admissão, maior mortalidade e maior grau de dependência na alta (p >< 0,01). Foi realizada uma regressão logística para caracterizar a capacidade preditiva da NLR (≥3) e do A2DS2 (≥6) na probabilidade de desenvolver PSP (p < 0,005). O modelo explicou 17,1% (Nagelkerke R2) da variância nos diagnósticos de pneumonia, classificando corretamente 77,0% dos doentes com uma especificidade de 96,3%. Doentes com A2DS2 ≥6 (OR 8,36, p < 0,01) e doentes com NLR ≥3 (OR 2,35, p < 0,01) apresentaram um maior risco de desenvolver pneumonia.
Conclusão: NLR parece estar relacioando com a gravida[1]de dos AIS, possivelmente como marcador de ativação neuroimune. Avanços na compreensão dos efeitos imunobiológicos da isquemia no cérebro poderão levar a desenvolvimentos terapêuticos futuros. Atualmente, sendo um biomarcador relativamente pouco dispendioso, talvez exista um papel da NLR na melhoria das escalas preditoras de PSP
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