中性粒细胞与淋巴细胞比值与脓毒症患者急性肾损伤发生的相关性

The relation between the neutrophil to lymphocyte ratio and the occurrence of acute renal injury in sepsis patients

目的:探讨脓毒症患者入院时中性粒细胞与淋巴细胞比值(NLR)与其发生AKI的相关性。方法:将2014-03—2019-03期间入住我院ICU的268例脓毒症患者作为研究对象。对患者是否并发AKI作出诊断,后将其分为AKI组和非AKI组(N-AKI组),2组患者入院时的NLR进行分析比较;同时,分别采用Logistic回归模型及ROC曲线,分析入院时NLR对脓毒症患者AKI发生的预测价值。结果:AKI组患者NLR明显高于N-AKI组(17.42±5.46 vs.9.63±4.68,P<0.05);同时,脓毒症患者NLR与血肌酐(r=0.231,P=0.009)、血尿素氮(r=0.198,P=0.008)呈显著正相关,而与估计肾小球滤过率(eGFR)呈明显的负相关(r=-0.189,P=0.002);另外,多因素Logistic回归显示入院时APACHEⅡ评分、PCT和NLR均为脓毒症患者AKI发生的独立预测因素,而NLR作为预测脓毒症患者AKI发生的AUC为0.651,其截断值为16.83,敏感度为0.71,特异度为0.63。结论:NLR作为临床上一项简易廉价的指标,可作为早期脓毒症患者发生AKI的有效预测指标。

Objective:To investigate the association of the neutrophil-to-lymphocyte ratio(NLR)measured at the time of admission and the occurrence of acute kidney injury(AKI)in sepsis patients.Method:From March 2014 to March 2019,268 patients with sepsis admitted to ICU of the Affiliated Zhangjiagang Hospital of Soochow University were studied.The patients were divided into AKI group and non-AKI group(N-AKI group).The NLR at admission was analyzed and compared between the two groups.Meanwhile,Logistic regression model and ROC curve were both used to analyze the predictive value of NLR in the occurrence of AKI in sepsis patients.Result:The NLR in AKI group was significantly higher than that in N-AKI group(17.42±5.46 vs.9.63±4.68,P<0.05).Meanwhile,NLR was positively correlated with serum creatinine(r=0.231,P=0.009)and urea nitrogen(r=0.198,P=0.008)in sepsis patients,but negatively correlated with estimated glomerular filtration rate(eGFR)(r=-0.189,P=0.002).In addition,multivariate Logistic regression showed that the APACHEⅡscore,PCT and NLR at admission were all independent predictors of the occurrence of AKI in sepsis patients,and NLR as the AUC for predicting the occurrence of AKI in sepsis patients was 0.651 and its cut-off value was 16.83 The sensitivity is 0.71 and the specificity is 0.63.Conclusion:NLR,as a simple and inexpensive clinical indicator,can effectively predict the occurrence of AKI in sepsis patients in early stage.