CRP、PCT、NLR联合检测预警输尿管结石发生尿源性脓毒血症的临床研究

Combined detection of CRP, PCT and NLR for early warning of urinary sepsis in ureteral calculi: report of 215 cases

目的探讨C-反应蛋白(c-reactive protein,CRP)、血清降钙素原(procalcitonin,PCT)和中性粒细胞与淋巴细胞比例(neutrophil to lymphocyte ratio,NLR)早期预警输尿管结石患者发生尿源性脓毒血症的临床效能。方法本研究采用病例-对照研究设计。选取2018年1月至2020年12月保定市第一中心医院泌尿外一科收治的215例确诊为输尿管结石合并尿路感染的患者作为研究对象;其中164例未发生脓毒血症患者作为普通感染组,51例发生尿源性脓毒血症的患者作为脓毒血症组。通过Logistic回归分析CRP、PCT、NLR与尿源性脓毒血症的关系,计算3种炎症指标的联合检测因子并绘制受试者工作曲线(receiver operating characteristic curve,ROC),评估CRP、PCT、NLR及联合检测对输尿管结石合并尿源性脓毒血症的早期预警价值。结果脓毒血症组炎症因子水平CRP[142.00(75.90,207.00)mg/L]、PCT[10.58(0.64,64.85)ng/mL]、NLR[19.29(9.65,28.46)]均明显高于普通感染组[CRP:22.25(6.11,79.20)mg/L、PCT:0.07(0.01,0.29)ng/mL、NLR:3.99(2.61,7.24)]。CRP+PCT+NLR联合检测的受试者工作曲线下面积(area under the subject curve,AUC)为0.902,敏感性为0.902,阳性预测值为74.60%,阴性预测值为97.37%,准确度为90.70%,均高于CRP(AUC=0.834,敏感性为0.902,阳性预测值为45.10%,阴性预测值为95.58%,准确度为71.63%)、PCT(AUC=0.866,敏感性为0.745,阳性预测值为67.86%,阴性预测值为91.82%,准确度为85.58%)、NLR(AUC=0.895,敏感性为0.882,阳性预测值为54.22%,阴性预测值为95.45%,准确度为79.53%)3种指标单独检测。CRP+PCT+NLR联合检测漏诊率为7.84%、误诊率为9.76%,低于3种指标单独检测[CRP:漏诊率为9.80%、误诊率为34.15%,PCT:漏诊率为25.49%、误诊率为10.98%,NLR:漏诊率为11.76%、误诊率为23.17%]。结论CRP、PCT、NLR及3种指标联合检测可以作为输尿管结石合并尿源性脓毒血症的早期预警指标,CRP、PCT、NLR联合检测的预警价值更高。

Objective To explore the clinical efficacy of C-reactive protein(CRP),serum procalcitonin(PCT)and neutrophil to lymphocyte ratio(NLR)in early warning of urinary sepsis for the patients with ureteral calculi.Methods A total of 215 patients diagnosed with ureteral calculi and urinary tract infection admitted to the First Department of Urology of Baoding First Central Hospital from January 2018 to December 2020 were selected in this case-control study.Among them,164 patients without sepsis were served as the common infection group,and the other 51 patients with identified urinary sepsis were regarded as the sepsis group.Logistic regression analysis was used to analyze the relationship of CRP,PCT and NLR with urinary sepsis.Receiver operating characteristic(ROC)curve was drawn to evaluate the early warning values of CRP,PCT and NLR respectively,and their combination for urinary sepsis in ureteral calculi patients.Results The sepsis group had significantly higher CRP[142.00(75.90,207.00)vs 22.25(6.11,79.20)mg/L],PCT[10.58(0.64,64.85)vs 0.07(0.01,0.29)ng/mL]and NLR[19.29(9.65,28.46)vs 3.99(2.61,7.24)]than the common infection group.Combined detection of CRP+PCT+NLR obtained an area under the curve(AUC)of 0.902,sensitivity of 0.902,positive and negative predictive values of 74.60%and 97.37%,and diagnostic accuracy of 90.70%.And all of these values were higher than CRP(AUC=0.834,sensitivity=0.902,positive and negative predictive values=45.10%and 95.58%,diagnostic accuracy=71.63%),PCT(AUC=0.866,sensitivity=0.745,positive and negative predictive values=67.86%and 91.82%,diagnostic accuracy=85.58%)and NLR(AUC=0.895,sensitivity=0.882,positive and negative predictive values=54.22%and 95.45%,diagnostic accuracy=79.53%)alone.For the combined detection,the missed diagnosis rate was 7.84%,and the misdiagnosis rate was 9.76%,and both were lower than those of above 3 indicators alone.The missed diagnosis rate was 9.80%,25.49%and 11.76%,while the misdiagnosis rate was 34.15%,10.98%and 23.17%,respectively for CRP,PCT and NLR.Conclusion The combined detection of CRP,PCT and NLR and alone can be regarded as early warning indicator for the occurrence of urinary sepsis in the patients with ureteral calculi.Compared with the single detection,the combined detection had more significant values in the early warning,and in reducing the rates of missed diagnosis and misdiagnosis,with significantly higher sensitivity and accuracy of diagnosis.