Association of Lymphocyte to Monocyte Ratio and Risk of in-Hospital Mortality in Patients with Cardiogenic Shock: A Propensity Score Matching Study

Figures & data

Table 1 Comparisons of Baseline Characteristics Between the Original Cohort, Matched Cohort and Weighted Cohort

Covariate	Original Cohort			Matched Cohort			Weighted Cohort
	High LMR	Low LMR	SMD	High LMR	Low LMR	SMD	High LMR	Low LMR	SMD
N	912	575	–	547	547	–	528.4	536.2	–
Age, years	68.5(14.6)	70.2(14.6)	0.122	69.8(14.3)	70.0(14.7)	0.023	69.8(14.5)	70.0(14.7)	0.013
Gender, male, n(%)	554(60.7)	343(59.7)	0.022	330(60.3)	327(59.8)	0.011	317.1(60.0)	320.8(59.8)	0.004
Weight (kg)	83.2(22.2)	80.7(21.7)	0.117	80.6(20.8)	80.7(21.8)	0.008	81.0(21.4)	81.0(21.9)	0.002
Ethnicity, n(%)
White	569(62.4)	383(66.6)	0.093	368(67.3)	363(66.4)	0.029	351.1(66.4)	355.6(66.3)	0.006
Black	119(13.0)	71(12.3)		63(11.5)	68(12.4)		63.5(12.0)	65.5(12.2)
Other	224(24.6)	121(21.0)		116(21.2)	116(21.2)		113.8(21.5)	115.1(21.5)
Interventions, n(%)
MV use	612(67.1)	366(63.7)	0.073	336(61.4)	352(64.4)	0.061	334.8(61.4)	342.0(63.8)	0.009
RRT use	129(14.1)	86(15.0)	0.023	80(14.6)	79(14.4)	0.005	73.2(13.9)	75.7(14.1)	0.008
Score Systerm
SOFA	9.0(4.0)	8.9(4.1)	0.022	8.8(4.0)	8.9(4.1)	0.029	8.9(4.0)	8.9(4.1)	0.007
OASIS	38.0(9.9)	38.5(10.2)	0.048	38.3(9.9)	38.4(10.1)	0.010	38.4(9.9)	38.3(10.2)	0.001
APSIII	66.3(27.0)	69.8(28.6)	0.126	68.9(27.0)	69.1(28.4)	0.008	69.1(27.5)	68.9(28.2)	0.006
SAPSII	46.4(15.0)	47.4(15.8)	0.064	46.6(15.0)	47.1(15.5)	0.032	47.0(15.2)	47.1(15.6)	0.005
Comorbidities, n(%)
Hypertension	362(39.7)	222(38.6)	0.022	195(35.6)	208(38.0)	0.049	198.6(37.6)	208.3(38.9)	0.026
Diabetes	333(36.5)	214(37.2)	0.015	203(37.1)	204(37.3)	0.004	193.2(36.6)	197.2(36.8)	0.004
CKD	351(38.5)	231(40.2)	0.035	231(42.2)	221(40.4)	0.037	212.8(40.3)	214.6(40.0)	0.005
CAD	591(68.5)	340(59.1)	0.117	328(60.0)	327(59.8)	0.004	320.4(60.6)	326.5(60.9)	0.006
CHF	721(79.1)	461(80.2)	0.028	443(81.0)	437(79.9)	0.028	420.2(79.5)	427.1(79.7)	0.003
COPD	248(27.2)	192(33.4)	0.135	176(32.2)	175(32.0)	0.004	164.6(31.1)	168.2(31.4)	0.005
Liver disease	109(12.0)	100(17.4)	0.154	82(15.0)	89(16.3)	0.035	82.6(15.6)	86.7(16.2)	0.015
Malignancy	75(8.2)	48(8.3)	0.005	50(9.1)	47(8.6)	0.019	47.5(9.0)	44.8(8.4)	0.022
Vital signs
MAP, mmHg	105.7(33.0)	103.5(31.8)	0.069	103.1(27.6)	103.5(32.4)	0.013	103.9(28.5)	103.9(32.3)	0.001
Heart rate, bpm	89.6(18.0)	88.7(18.4)	0.053	89.3(18.1)	88.6(18.4)	0.037	89.0(18.4)	88.9(18.4)	0.007
RR, bpm	29.9(6.9)	29.5(6.3)	0.070	29.7(6.4)	29.5(6.3)	0.033	29.6(6.5)	29.5(6.3)	0.009
Temperature, ^oC	36.1(1.0)	36.0(1.0)	0.053	36.1(1.0)	36.1(1.0)	0.021	36.1(1.0)	36.1(1.0)	0.007
SpO2, %	99.5(1.4)	99.5(1.4)	0.006	99.5(1.5)	99.5(1.4)	0.001	99.6(1.4)	99.5(1.4)	0.012
Laboratory Results
WBC, × 109/L	15.0(11.0, 19.5)	15.8(11.0,21.3)	0.122	14.9(11.1, 19.6)	14.3(10.2, 20.0)	0.035	15.4(12.0, 20.1)	15.6(11.2, 21.1)	0.010
HGB, g/dL	9.9(2.4)	10.3(2.4)	0.180	10.3(2.4)	10.3(2.4)	0.025	10.3(2.4)	10.3(2.4)	0.008
PLT, × 109/L	171(92.7)	190.4(98.4)	0.203	187.5(94.3)	188.4(98.6)	0.010	188.5(99.4)	187.6(95.8)	0.010
Bilirubin, mmol/L	1.1(1.5)	1.1(1.4)	0.037	1.1(1.3)	1.1(1.5)	0.011	1.1(1.4)	1.1(1.4)	0.007
Aniongap, mEq/L	14.7(3.8)	15.1(4.6)	0.106	15.1(3.9)	15.1(4.6)	<0.001	15.1(3.8)	15.0(4.5)	0.011
Bicarbonate, mEq/L	23.2(4.4)	23.7(4.9)	0.122	23.7(4.7)	23.6(4.8)	0.015	23.6(4.7)	23.6(4.8)	0.003
BUN, mg/dL	30.0(19.0, 48.0)	27.0(18.0, 29.0)	0.114	30.0(19.0, 47.0)	29.0(20.0, 49.0)	0.010	33.0(21.0, 48.0)	34.0(22.0, 49.0)	0.018
Creatinine, mg/dL	1.7(1.3)	1.9(1.4)	0.099	1.9(1.4)	1.9(1.4)	0.016	1.9(1.5)	1.9(1.4)	0.013
Potassium, mmol/L	4.0(0.6)	3.9(0.7)	0.036	4.0(0.6)	3.9(0.7)	0.017	4.0(0.6)	3.9(0.7)	0.011
Sodium, mmol/L	135.4(5.8)	134.7(5.5)	0.124	134.8(5.9)	134.8(5.4)	0.006	134.8(6.1)	134.8(5.4)	0.001
Calcium, mg/dL	8.1(0.9)	8.0(0.9)	0.070	8.0(0.9)	8.0(0.9)	0.008	8.0(0.9)	8.0(0.9)	0.004
PT, s	14.9(12.8, 20.3)	14.1(12.5, 18.1)	0.165	14.9(12.7, 19.9)	14.6(13.2, 19.9)	0.011	15.6(14.5, 22.3)	16.8(14.3, 23.1)	<0.001
APTT, s	35.5(16.2)	36.7(16.6)	0.072	36.2(16.9)	36.5(16.2)	0.018	36.7(17.6)	36.6(16.6)	0.006
INR	1.6(1.0)	1.8(1.0)	0.154	1.7(1.1)	1.7(1.0)	0.005	1.7(1.1)	1.7(1.0)	0.001

Note: For all continuous covariates, the mean values and standard deviations are reported.

Abbreviations: LMR, lymphocyte-to-monocyte ratio; SMD, standardized mean difference; MV, mechanical ventilation; RRT, renal replacement therapy; SOFA, sequential organ failure assessment; OASIS, oxford acute severity of illness score; APSIII, acute physiology score III; SAPS II, Simplified Acute Physiology Score II; CKD, chronic kidney disease; CAD, coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; MAP, mean arterial pressure; RR, respiratory rate; WBC, white blood cell; HGB, hemoglobin; PLT, platelet; BUN, blood urea nitrogen; PT, prothrombin time; APTT, activated partial thromboplastin time; INR, international normalized ratio.

Figure 1 The flow chart of the included population.

Figure 2 Overall survival of high-LMR and low-LMR groups. Kaplan–Meier curve (A) before and (B) after PSM.

Table 2 Summary of Results of Primary Outcome and Sensitivity Analysis

	Original Cohort		Matched Cohort		Weighted Cohort
	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value
Unadjusted	1.40(1.12–1.74)	0.003	1.31(1.08–1.68)	0.016	1.20(1.06–1.51)	0.024
Model 1	1.37(1.10–1.71)	0.006	1.30(1.06–1.64)	0.018	1.20(1.05–1.52)	0.032
Model 2	1.33(1.06–1.68)	0.015	1.26(1.02–1.63)	0.037	1.22(1.04–1.55)	0.038
Model 3	1.38(1.06–1.79)	0.018	1.38(1.03–1.84)	0.030	1.31(1.01–1.72)	0.045

Notes: Model 1 adjusted for age, gender, weight, ethnicity. Model 2 adjusted for model 1 plus comorbidities. Model 3 adjusted for model 2 plus score system, interventions, vital signs and laboratory results. It would be better if significant p values were expressed in bold characters.

Table 3 NRI and IDI Analyses for Risk Reclassification of in Hospital Mortality in Original Cohort and Matched Cohort

Outcome	Sensibility (%)	Specificity (%)	AUC				IDI		NRI^a
			Biomaker	Biomaker+Clinical Model	Clinical Model^b	P value^c	Value (95% CI)	P value	Value (95% CI)	P value
Original Cohort
LMR	65.0	67.3	0.706	0.795	0.751	<0.001	0.021(0.003–0.045)	0.020	0.121(0.014–0.214)	<0.001
SOFA	60.8	62.9	0.658	0.793		0.086	−0.002(−0.007–0.005)	0.515	−0.023(−0.124–0.062)	0.614
LMR+SOFA	60.6	72.0	0.710	0.798		0.001	0.018(0.001–0.045)	0.045	0.110(0.001–0.216)	0.030
Matched 1cohort
LMR	56.7	75.7	0.707	0.785	0.770	0.017	0.032(0.007–0.058)	<0.001	0.124(0.007–0.246)	0.031
SOFA	60.9	65.5	0.671	0.777		0.054	0.012(−0.002–0.035)	0.109	0.055(−0.060–0.176)	0.259
LMR+SOFA	63.3	69.4	0.714	0.799		0.013	0.032(0.010–0.057)	0.011	0.104(0.001–0.249)	0.045

Notes: ^aThe NRI is calculated through two-way category by using the event rate of in hospital mortality, ^bThe clinical model for predicting in hospital mortality are composed of age, gender, weight, ethnicity, comorbidities, interventions, vital signs and laboratory results, ^cBiomarker+clinical model versus clinical model. It would be better if significant p values were expressed in bold characters.

Abbreviations: AUC, area under the receiver-operating characteristic curve; IDI, integrated discrimination improvement; NRI, net reclassification index; LMR, lymphocyte-to-monocyte ratio, SOFA, sequential organ failure assessment.

Table 4 Compared the Predictive Effect of LMR with SII Inin Hospital Mortality in Original Cohort and Matched Cohort

	Sensibility (%)	Specificity (%)	AUC (95% CI)	P value
Original Cohort				<0.001
SII	56.5	61.6	0.612(0.587–0.637)
LMR	65.0	67.3	0.706(0.684–0.731)
Matched Cohort				0.018
SII	62.7	64.5	0.671(0.642–0.699)
LMR	56.7	75.7	0.707(0.677–0.732)

Note: It would be better if significant p values were expressed in bold characters.

Abbreviations: AUC, area under the receiver-operating characteristic curve; LMR, lymphocyte-to-monocyte ratio; SII, systemic immune-inflammatory index.