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. 2025 Jun 27;14(6):1073-1086.
doi: 10.21037/tp-2025-21. Epub 2025 Jun 25.

Association of monocyte to lymphocyte ratio with length of stay in intensive care unit in neonatal apnea modified by treatment

Juan Chen  1 , Feng Han  2
Affiliations

Association of monocyte to lymphocyte ratio with length of stay in intensive care unit in neonatal apnea modified by treatment

Juan Chen et al. Transl Pediatr. .

Abstract

Background: Apnea is a common condition among neonates admitted to the intensive care unit (ICU), often leading to prolonged hospitalization and increased healthcare burden. This study aimed to investigate the association between monocyte to lymphocyte ratio (MLR) and length of stay (LOS) in the ICU among neonates diagnosed with apnea.

Methods: Data were extracted from the Medical Information Mart for Intensive Care III (MIMIC III) database. Collinearity analysis excluded variables with a variance inflation factor >2. Generalized additive models (GAM) explored the nonlinear relationship between MLR and ICU LOS. Three generalized linear models (GLMs) assessed associations between MLR and LOS, adjusting for various factors. Mediation analysis evaluated MLR's role between intraventricular hemorrhage (IVH)/caffeine/mechanical ventilation and LOS in the ICU.

Results: A total of 1,120 neonates with apnea were included in this study. Neonates in the high MLR group had a significantly longer LOS in the ICU compared to the low MLR group. GAM analysis indicated a non-linear relationship between MLR and LOS in the ICU. In adjusted GLM analyses, higher MLR levels were positively correlated with increased LOS in the ICU {β=5.576 [95% confidence interval (CI): 2.270, 8.881], P=0.001} and LOS in the hospital [β=5.529 (95% CI: 2.237, 8.820), P=0.001]. Subgroup analyses revealed that MLR's association with LOS in the ICU was influenced by IVH and treatments such as caffeine and mechanical ventilation, with mediation analysis confirming MLR as a mediator in these contexts.

Conclusions: MLR is significantly associated with increased LOS in the ICU among neonates with apnea, with treatment factors modifying this relationship.

Keywords: Neonatal apnea; clinical outcome; intensive care unit (ICU); lymphocyte; monocyte.

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Conflict of interest statement

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-21/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of inclusion and exclusion criteria. ICU, intensive care unit; LOS, length of stay; MIMIC III, Medical Information Mart for Intensive Care III; MLR, monocyte to lymphocyte ratio.
Figure 2
Figure 2
Nonlinear relationships between MLR and LOS in the ICU. (A) GAM analysis in the unadjusted model. (B) GAM analysis in the model adjusting variables with VIF ≤2. The blue line represents coefficient values, the top red line is the 95% confidence interval high, and the bottom red line is the 95% confidence interval low. GAM, generalized additive model; ICU, intensive care unit; LOS, length of stay; MLR, monocyte to lymphocyte ratio; VIF, variance inflation factor.
Figure 3
Figure 3
Mediation analysis. (A) MLR was a mediator between IVH and LOS in the ICU. (B) MLR was a mediator between caffeine and LOS in the ICU. (C) MLR was a mediator between mechanical ventilation and LOS in the ICU. ICU, intensive care unit; IVH, intraventricular hemorrhage; LOS, length of stay; MLR, monocyte to lymphocyte ratio.
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References

    1. Martin RJ, Abu-Shaweesh JM, Baird TM. Apnoea of prematurity. Paediatr Respir Rev 2004;5 Suppl A:S377-82. - PubMed
    1. Dong LB, Li YF, Zhang Y, et al. A pilot study of limb stimulation for the treatment of neonatal apnea. Medicine (Baltimore) 2018;97:e12827. 10.1097/MD.0000000000012827 - DOI - PMC - PubMed
    1. Vitaliti G, Falsaperla R. Chorioamnionitis, Inflammation and Neonatal Apnea: Effects on Preterm Neonatal Brainstem and on Peripheral Airways: Chorioamnionitis and Neonatal Respiratory Functions. Children (Basel) 2021;8:917. 10.3390/children8100917 - DOI - PMC - PubMed
    1. Lopes JM. Neonatal apnea. J Pediatr (Rio J) 2001;77 Suppl 1:S97-103. 10.2223/jped.223 - DOI - PubMed
    1. Shirwaikar RD, Acharya U D, Makkithaya K, et al. Optimizing neural networks for medical data sets: A case study on neonatal apnea prediction. Artif Intell Med 2019;98:59-76. 10.1016/j.artmed.2019.07.008 - DOI - PubMed

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