Нові можливості оцінювання ризику розвитку госпітальних ускладнень у хворих з гострим інфарктом міокарда з елевацією сегмента ST за даними вивчення клітинного складу крові

Abstract

The aim – to create a new method of assessing the development of hospital complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 317 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=214). Group 2 – 103 patients, who were studied prospectively. The group of patients did not differ in clinical and anamnestic characteristics and treatment. An index of hospital complications was created for assessing the criteria of the severity of the clinical course.Results and discussion. A number of correlation analyses were performed to examine the relationships between white blood components, platelet heterogeneity and systemic inflammation, and the hospital complication index. On the basis of these data we have built a complex index – leukocyte-platelet index (LTI): LTI (conditional unit) = ((GRA – MON) / LYM) · 10 + PDWc + P-LCR, where: GRA is the number of granulocytes in the blood test, MON is the number of monocytes, LYM is the number of lymphocytes, PDWc is the percentage of platelet distribution by size, and P-LCR is the percentage of large (> 12fL) platelets. When assessing in group 1 correlations with the index of nosocomial complications and combined indicators: neutrophil-lymphocyte ratio (NLR) and the LTI index created by us showed the highest degree of correlation with the index of hospital complications (p<0.001 and p<0.0005, respectively). When the value of LTI > 137 conventional units can be judged on the increased risk of nosocomial complications of AMI (sensitivity 64 %, specificity 78 %, area under the curve 0.72). Thus, in a prospective approbation study, the LTI on the first day of AMI was significantly (p<0.05) better than other indicators, in particular, better than the widely used leukocyte marker NLR in determining the susceptibility to the undesirable course of the hospital period of the disease.Conclusions. The created computer algorithm for calculating the risk index of complications in patients with AMI on the first day can be widely implemented in modern health care facilities in Ukraine.