Association between white blood cell count to hemoglobin ratio and risk of in-hospital mortality in patients with lung cancer.

ABSTRACT

BACKGROUND: The objective of this study was to investigate the association between white blood cell count to hemoglobin ratio (WHR) and risk of in-hospital mortality in patients with lung cancer. METHODS: In this retrospective cohort study, the medical records of patients with lung cancer were retrieved from the electronic ICU (eICU) Collaborative Research Database between 2014 and 2015. The primary outcome was in-hospital mortality. The secondary outcome was the length of stay in intensive care unit (ICU). The cut-off value for the WHR was calculated by the X-tile software. The Cox model was applied to assess the association between WHR and in-hospital mortality among patients with lung cancer and the linear regression model was used to investigate the association between WHR and length of ICU stay. Subgroup analyses of age (< 65 years or > = 65 years), Acute Physiology and Chronic Health Evaluation (APACHE) score (< 59 or > = 59), gender, ventilation (yes or no), and vasopressor (yes or no) in patients with lung cancer were conducted. RESULTS: Of the 768 included patients with lung cancer, 153 patients (19.92%) died in the hospital. The median total follow-up time was 6.88 (4.17, 11.23) days. The optimal cut-off value for WHR was 1.4. ICU lung cancer patients with WHR > = 1.4 had a significantly higher risk of in-hospital mortality [Hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.15 to 2.38, P = 0.007) and length of stay in ICU (HR 0.63, 0.01, 95% CI 1.24 to 0.045, P = 0.045). According to the subgroup analysis, WHR was found to be associated with in-hospital mortality in patients with higher APACHE score (HR 1.60, 95% CI 1.06 to 2.41, P = 0.024), in male patients (HR 1.87, 95% CI 1.15 to 3.04, P = 0.012), and in patients with the treatment of ventilation (HR 2.33, 95% CI 1.49 to 3.64, P < 0.001). CONCLUSION: This study suggests the association between WHR and risk of in-hospital mortality in patients with lung cancer and length of stay, which indicates the importance of attention to WHR for patients with lung cancer.