中性粒细胞/淋巴细胞比值对呼吸机相关性肺炎病情严重程度及预后的评估价值

The Value of Neutrophil/lymphocyte Ratio in Assessing the Severity and Prognosis of Ventilator-associated Pneumonia

目的: 探讨中性粒细胞/淋巴细胞比值(NLR)对呼吸机相关性肺炎(VAP)病情严重程度及预后的评估价值。 方法: 回顾性分析2014年12月至2018年12月我院收治的210例VAP患者临床资料,根据患者入科24h内急性生理与慢性健康状况评分(APACHE II)情况,将其分为低危组(APACHE II评分< l0分,67例)、中危组(10≤APACHE II评分≤20分,70例)和高危组(APACHE II评分>20分,73例)。根据临床预后将其分为存活组(159例)和死亡组(51例)。记录不同组间患者一般临床资料,包括APACHE II评分、临床肺部感染严重程度评分(CPIS评分)、序贯器官衰竭评分(SOFA评分)、中性粒细胞计数(neutrophil, NEU)、淋巴细胞计数(lymphocyte, LYM)、NLR、降钙素原(procalcitonin, PCT)、高敏C反应蛋白(hypersensitive C reactive protein, hs-CRP)。采用Logistics回归、相关性分析及ROC曲线对不同组间相关数据进行统计分析。 结果: 不同严重程度组间NLR水平比较,差异有统计学意义(P<0.05),其中高危组最高,中危组次之,低危组最低。死亡组NLR水平显著高于存活患者,差异具有统计学意义(P<0.05)。多因素logistic回归分析显示,NLR、前白蛋白(PA)、APACHE II评分、CPIS评分及SOFA评分是VAP患者预后不佳的独立危险因素;相关性分析显示,死亡组患者NLR水平与APACHE II评分、CPIS评分及SOFA评分呈正相关(r1=0.842,P1<0.001;r2=0.805,P2<0.001;r3=0.901,P3<0.001),而与PA水平呈显著负相关(r= -7.047,P<0.001)。ROC曲线分析显示,NLR的曲线下面积(AUC)为0.833(95%CI:0.735~0.931),对预后不佳具有较高的预测价值,其阈值点为9.52,敏感性为81.58 %和特异性为74.16%。 结论: NLR水平对于评估VAP患者病情严重程度及预后,具有较高的预测价值,值得临床推广。

Objective: To evaluate the value of neutrophil/lymphocyte ratio in assessing the severity and prognosis of ventilator-associated pneumonia(VAP). Methods: The clinical data of 210 patients with VAP who were admitted to our hospital from December 2014 to December 2018 were analysized retrospectively. According to the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) within 24 hours, the patients were divided into low risk group(APACHE Ⅱ score <10, 67 cases), intermediate risk group(10≤APACHE Ⅱ score≤20, 70 cases) and high-risk group(APACHE Ⅱ score > 20, 73 cases). According to clinical prognosis, they were divided into survival group(159 cases) and death group(51 cases). The clinical data of the patients in different groups were recorded including APACHE Ⅱ score, clinical pulmonary infection score(CPIS), sepsis related organ failure assessment(SOFA), neutrophil(NEU),(lymphocyte(LYM), NLR, procalcitonin,(PCT), hypersensitive C reactive protein(hs-CRP). The logistics regression, correlation analysis and receiver operator characteristic curve(ROC) were used to analyze the data of different groups. Results: The difference of NLR levels among different severity groups was statistically significant(P<0.05), which high-risk group was the highest, intermediate risk group was the second, and low risk group was the lowest. The NLR level in the death group was significantly higher than that in the surviving group, the difference was statistically significant(P<0.05). The multivariate logistic regression analysis showed that NLR, prealbumin(PA), APACHE Ⅱ, CPIS, SOFA were independent risk factors for poor prognosis. The correlation analsis showed that NLR level in the death group were positively correlated with APACHE Ⅱ score, CPIS score, and SOFA score(r1=0.842, P1<0.001;r2=0.805, P2<0.001;r3=0.901, P3<0.001). There was a significant negative correlation between NLR and PA levels(r=-7.047, P<0.001). ROC curves analysis showed that the area under curve of NLR level was 0.833(95%CI:0.735~0.931), and threshold(OOP) was 9.52, which had 81.58% sensitivity and 81.58% specificity in predicting poor prognosis. Conclusions: The NLR level has a high predictive value for assessing the severity and prognosis of patients with VAP, which is worthy of clinical promotion.