外周血炎性指标对高龄患者血培养阳性的预测价值

Evaluation of inflammatory indexes for predicting blood culture positive results in elderly patients

目的探讨WBC、中性粒细胞比例(NEUT%)、CRP、IL-6、降钙素原(procalcitonin, PCT)5种炎性指标单独及联合检测对高龄患者血培养阳性的预测价值。方法前瞻性分析2016年6月至2017年6月入住北京市第二医院的高龄患者274例。所有患者均抽血进行培养,同时检测血中5种炎性指标,根据血培养结果分为血培养阳性组和血培养阴性组。比较2组炎性指标的差异,以ROC曲线评价各炎性指标单独与联合应用对血培养阳性的预测价值。结果 2组WBC、NEUT%、PCT、CRP、IL-6差异均有统计学意义(P<0.05)。PCT和NEUT%AUC为0.791和0.715,预测高龄患者血培养阳性的准确性为中等。WBC、CRP、IL-6的AUC分别为0.614、0.629、0.661,准确性较低。PCT、NEUT%和IL-6联合检测的AUC为0.825,敏感度为70.5%,特异度为82.6%,高于各指标单独检测。结论 PCT、NEUT%和IL-6联合检测能够为临床预测高龄患者血培养阳性提供一定预警信息。

Objective To investigate the value of inflammatory indexes including WBC, neutrophil ratio（NEUT%）, CRP, IL-6, procalcitonin（PCT） and combined of them for predicting blood culture positive results in elderly patients. Methods A total of 274 elderly patients in The Second Hospital of Beijing from June 2016 to June 2017 was selected for prospective analysis. All patients were detected by blood culture, inflammatory indexes including WBC,NEUT%, CRP, IL-6 and PCT. According to the results of blood culture, the patients were categorized into blood culturepositive group and blood culture-negative group. The level of inflammatory indexes between two groups were compared statistically. Receiver operating characteristic（ROC） curve was used to analyze the predictive value of inflammatory indexes in blood culture positive by single and combined application. Results The level of WBC, NEUT%, CRP, IL-6 and PCT were significantly different between the two groups（P〈0.05）. The area of PCT and NEUT% under ROC curve were 0.791 and 0.715 respectively. The accuracy of PCT and NEUT% for predicting blood culture results were moderate. The area of WBC, CRP and IL-6 under ROC curve were 0.614, 0.629 and 0.661, the accuracy of which for predicting blood culture results were low. The area under ROC curve of the combination of PCT, IL-6 and NEUT% was 0.825, the sensitivity was 70.5%, and the specificity was 82.6%, which was higher than that of single index. Conclusion The combination of PCT, NEUT% and IL-6 can be a valuable indicator for predicting blood culture results in elderly patients.