中性粒细胞与淋巴细胞比值和C反应蛋白与淋巴细胞比值对老年脓毒症患者28天病死率的预测价值

Predictive value of neutrophil/lymphocyte ratio and C-reactive protein/lymphocyte ratio for 28-day mortality in elderly patients with sepsis

目的探讨中性粒细胞与淋巴细胞比值(NLR)、C反应蛋白与淋巴细胞比值(CLR)对老年脓毒症患者28 d病死率的预测价值。方法选取2017年1月至2021年1月浙江医院收治的330例老年脓毒症患者,收集患者的一般资料、临床检查指标,以及随访28 d的存活情况。采用单因素分析(包括t检验、秩和检验、χ^(2)检验)比较存活组患者与死亡组患者的各项指标,采用Logistic回归分析老年脓毒症患者28 d死亡的独立危险因素,绘制受试者工作特性(ROC)曲线,根据曲线下面积(AUC)评价相关指标对预后的预测价值。结果存活组177例,死亡组153例。两组患者APACHEⅡ评分、白蛋白、合并肾功能不全的比例、降钙素原(PCT)、C反应蛋白、乳酸、NLR、CLR、C反应蛋白与白蛋白比值(CAR)的差异均有统计学意义(t=-19.345、2.765,χ^(2)=4.905,Z=-7.672、-8.118、-5.826、-7.209、-9.992、-8.354;P<0.05或0.01)。NLR、CLR、PCT、乳酸和APACHEⅡ评分是老年脓毒症患者28 d预后的独立危险因素(P<0.05或0.01)。CLR的预测价值明显高于NLR和PCT(95%CI=0.036~0.142、0.005~0.144,P<0.05或0.01),CLR+PCT的预测价值明显高于NLR+PCT(95%CI=0.006~0.092,P<0.05)。结论对于老年脓毒症患者预后的短期预测,CLR较PCT更具优势,两者联合预测价值更大。

Objective To investigate the predictive value of neutrophil/lymphocyte ratio(NLR)and C-reactive protein/lymphocyte ratio(CLR)for 28-day mortality in elderly patients with sepsis.Methods A total of 330 elderly patients with sepsis admitted to Zhejiang Hospital from January 2017 to January 2021 were selected,and their general information,clinical examination indicators,and survival after 28 days of follow-up were collected.Univariate analysis(including t test,rank sum test and χ^(2) test)was used to compare various indicators of patients in the survival group and the death group.Logistic regression was used to analyze independent risk factors of death at 28 days.Receiver operating characteristic(ROC)curve was drawn,and area under the curve(AUC)was used to evaluate the prognostic value of relevant indicators.Results There were 177 patients in the survival group and 153 in the death group.There were statistically significant differences in acutephysiologyandchron-icheadlthevaluation(APACHE Ⅱ)score,albumin,proportion of renal dysfunction,procalcitonin(PCT),C-reactive protein,lactic acid,NLR,CLR,and C-reactive protein/albumin ratio(CAR)between the two groups(t=-19.345,2.765;χ^(2)=4.905;Z=-7.672,-8.118,-5.826,-7.209,-9.992,-8.354;P<0.05 or P<0.01).NLR,CLR,PCT,lactic acid and APACHEⅡscores were independent risk factors for 28-day prognosis in elderly patients with sepsis(P<0.05 or P<0.01).The predictive value of CLR was significantly higher than that of NLR and PCT(95%CI=0.036-0.142,0.005-0.144;P<0.05 or P<0.01),and the predictive value of CLR+PCT was significantly higher than that of NLR+PCT(95%CI=0.006-0.092,P<0.05).Conclusion For prediction of short-term prognosis in elderly sepsis patients,CLR has an advantage over PCT,and the combination of the two has greater predictive value.