中性粒细胞与淋巴细胞比值等指标对老年发热性尿路感染合并血流感染的预测价值

The predictive value of neutrophil-to-lymphocyte ratio and other indicators for febrile urinary tract infection complicated with bloodstream infection in elderly patients

目的探讨中性粒细胞与淋巴细胞比值(NLR)等指标对老年发热性尿路感染(FUTI)合并血流感染的预测价值。方法回顾性分析2016年1月至2019年10月海南医学院第二附属医院急诊科收治的390例老年FUTI患者的临床资料。比较血培养阳性与阴性患者性别、年龄、急性生理与慢性健康评估系统Ⅱ评分、基础疾病患病率、入院24 h内实验室指标及28 d病死情况,分析影响老年FUTI患者发生血流感染的危险因素,绘制ROC曲线评估其预测老年FUTI患者发生血流感染的效能。结果血培养阳性52例,阳性率为13.3%。与阴性组比较,阳性组患者WBC、中性粒细胞计数(N)、NLR、CRP、降钙素原(PCT)水平均明显升高,淋巴细胞计数(L)水平明显降低,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,NLR、CRP、PCT水平升高是影响老年FUTI患者发生血流感染的独立危险因素(OR=1.039、1.008、1.058,均P<0.05)。NLR、CRP、PCT及3者联合预测老年FUTI患者发生血流感染的AUC分别为0.829、0.817、0.853、0.908;3者联合检测的AUC最高,其灵敏度为0.865,特异度为0.813。结论NLR、CRP及PCT是老年FUTI患者发生血流感染的独立危险因素;NLR预测血流感染的效能与CRP、NLR相当,3者联合检测的预测效能最佳。

Objective To assess the predictive value of neutrophil-to-lymphocyte ratio(NLR)and other indicators for febrile urinary tract infection(FUTI)complicated with bloodstream infection in elderly patients.Methods The clinical data of 390 elderly patients with FUTI admitted to the emergency department of the Second Affiliated Hospital of Hainan Medical College from January 2016 to October 2019 were retrospectively analyzed.The gender distribution,age,acute physiology and chronic health evaluation II(APACHE II)scores,prevalence of underlying diseases,laboratory indicators within 24 h after admission and 28-d mortality were compared between patients with positive blood culture and negative blood culture.The risk factors associated with FUTI complicated with bloodstream infection in elderly patients were analyzed,and their predictive value for bloodstream infection was evaluated by ROC curve.Results Among 390 patients there were 52 patients with positive blood culture(13.3%).Compared with the negative group,the levels of WBC,neutrophil(N),NLR,CRP and procalcitonin(PCT)in the positive group were significantly increased,and lymphocyte(L)level was significantly decreased(all P<0.05).Multivariate logistic regression analysis showed that the increased levels of NLR,CRP and PCT were independent risk factor for FUTI complicated with bloodstream infection in elderly patients(OR=1.039,1.008,1.058,all P<0.05).The AUC of NLR,CRP,PCT and their combination to predict FUTI complicated with bloodstream infection in elderly patients were 0.829,0.817,0.853 and 0.908,respectively,and the AUC of the three combined detection was the highest,with the sensitivity of 0.865 and the specificity of 0.813.Conclusion NLR,CRP and PCT are independent risk factor for FUTI complicated with bloodstream infection in elderly patients.The predictive capability of NLR was equivalent to that of CRP and NLR,and NLR combined with CRP and PCT has the best predictive capability.