重症肺炎患者中性粒细胞/淋巴细胞比值和红细胞分布宽度及其28 d死亡风险的预测价值

Predictive Value of Neutrophil to Lymphocyte Ratio and Red Blood Cell Distribution Width on 28 d Mortality of Patients with Severe Pneumonia

目的:评估中性粒细胞/淋巴细胞比值(NLR)、红细胞分布宽度(RDW)水平对重症肺炎患者28 d死亡风险的预测价值。方法:回顾性分析本院80例重症肺炎患者的临床资料。依据治疗28 d后的存活状况分为存活组56例和死亡组24例。多因素Logistic回归分析患者死亡的高危因素,受试者工作特征曲线(ROC)评估NLR及RDW对重症肺炎患者28 d死亡风险的预测价值。结果:死亡组APACHE II评分、Murray肺损伤评分、SOFA评分、WBC、NEU、RDW、NLR、PCT和Lac均高于存活组,OI低于存活组,差异均有统计学意义。Logistic回归分析结果显示,RDW、NLR、Lac、OI和Murray肺损伤评分是重症肺炎患者28 d死亡的独立危险因素。NLR对重症肺炎患者死亡风险的AUC为0.753(95%CI0.627~0.878),当最佳截断值为0.460时,敏感度为78.1%,特异度为67.9%;RDW对重症肺炎患者死亡风险的AUC为0.746(95%CI0.621~0.870),当最佳截断值为0.477时,敏感度为65.6%,特异度为82.1%。结论:NLR、RDW是重症肺炎患者28 d死亡的独立危险因素。NLR及RDW对重症肺炎患者的28 d死亡风险具有良好的预测价值,可作为重症肺炎预后评估有效而简便的指标。

Objective To evaluate the predictive value of neutrophil to lymphocyte ratio(NLR)and red blood cell distribution width(RDW)on 28 d mortality of patients with severe pneumonia.Methods The clinical data of 80 patients with severe pneumonia in our hospital were retrospectively analyzed.According to the survival status after 28 days of treatment,they were divided into 56 cases in the survival group and 24 cases in the death group.Multivariate logistic regression analysis was used to analyze the high risk factors of death in patients,and the receiver operating characteristic curve(ROC)evaluated the predictive value of NLR and RDW on 28-day mortality risk in patients with severe pneumonia.Results The APACHE II score,Murray lung injury score,SOFA score,WBC,NEU,RDW,NLR,PCT and Lac in the death group were higher than those in the survival group,and the OI was lower than that in the survival group.The differences were statistically significant.Logistic regression analysis showed that RDW,NLR,Lac,OI and Murray lung injury score were independent risk factors for 28-day death in patients with severe pneumonia.The AUC of NLR on the risk of death in patients with severe pneumonia is 0.753(95%CI 0.627 to 0.878).When the best cut-off value is 0.460,the sensitivity is 78.1%and the specificity is 67.9%;RDW is the risk of death in patients with severe pneumonia.The AUC is 0.746(95%CI 0.621 to 0.870).When the best cut-off value is 0.477,the sensitivity is 65.6%and the specificity is 82.1%.Conclusion NLR and RDW were independent risk factors for 28 d death of patients with severe pneumonia.NLR and RDW can predict the prognosis on 28 d mortality of patients with severe pneumonia,and can be used as an effective and simple index to evaluate the prognosis of severe pneumonia.