中性粒细胞/淋巴细胞比值早期预测脓毒症器官功能损伤及28d病死率的临床价值

Clinical value of neutrophil/lymphocyte ratio in early prediction of the incidence of organ dysfunction and 28-day mortality in patients with sepsis

目的评价中性粒细胞/淋巴细胞比值(NLR)早期预测脓毒症器官功能损伤发生率及28 d病死率的临床价值。方法采用回顾性研究方法,选择2017年1月至2019年12月中国医科大学附属第一医院重症医学科收治的成人脓毒症患者815例。收集患者的性别、年龄、合并症等临床资料和诊断脓毒症24、48及72 h的外周血常规指标,并计算NLR。研究的主要终点为脓毒症相关急性肾损伤(AKI)、急性呼吸窘迫综合征(ARDS)、弥散性血管内凝血(DIC)、急性肝衰竭(ALF)的发生率;次要终点为脓毒症合并器官功能损伤患者28 d内死亡。采用单因素和多因素Logistic回归分析影响脓毒症患者发生器官功能损伤及28 d病死率的危险因素,并绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),评估NLR对脓毒症患者发生器官功能损伤及28 d病死率的预测价值。结果共714例脓毒症患者纳入最终统计分析。诊断脓毒症24、48及72 h的NLR在发生器官功能损伤(AKI、ARDS、DIC、ALF)与未发生器官功能损伤患者间差异均无统计学意义。Logistic回归分析显示:诊断脓毒症24 h的NLR与28 d病死率无明显相关性〔优势比(OR)及95%可信区间(95%CI)为1.006(0.994-1.019),P=0.323〕;但诊断脓毒症48 h和72 h的NLR与28 d病死率之间均有显著相关性〔48 h NLR与28 d病死率的OR及95%CI为1.026(1.013-1.040),P=0.001;72 h NLR与28 d病死率的OR及95%CI为1.021(1.005-1.037),P=0.010〕,说明脓毒症诊断48 h和72 h的NLR是预测患者28 d病死率的独立危险因素。ROC曲线分析显示:诊断脓毒症48 h的NLR预测28 d病死率的AUC为0.598,95%CI为0.540-0.658,P=0.02;当NLR为10.1时预测28 d病死率的敏感度为75.2%,特异度为58.0%;诊断脓毒症72 h的NLR预测28 d病死率的AUC为0.595,95%CI为0.536-0.655,P=0.03;当NLR为9.24时预测28 d病死率的敏感度为75.3%,特异度为59.9%。结论NLR不能早期预测脓毒症相关AKI、ARDS、DIC、ALF的发生。NLR在预测脓毒症患者28 d病死率方面有一定的临床价值,但其预测效能偏低。

Objective To evaluate the clinical value of neutrophil/lymphocyte ratio(NLR)in early prediction of the incidence of sepsis-induced organ dysfunction and 28-day mortality.Methods A retrospective study was conducted in 815 adult patients with sepsis admitted to the department of critical care medicine of the First Affiliated Hospital of China Medical University from January 2017 to December 2019.The clinical data including age,gender and complication were collected,and the peripheral blood routine indexes at 24,48 and 72 hours after the diagnosis of sepsis were collected,and the NLR was calculated.The primary endpoint of the study was the incidences of sepsis related acute kidney injury(AKI),acute respiratory distress syndrome(ARDS),disseminated intravascular coagulation(DIC)and acute liver failure(ALF);the secondary endpoint was the 28-day in-hospital mortality in septic patients with organ dysfunction.Univariate and multivariate Logistic regression were used to analyze the risk factors of organ dysfunction and 28-day mortality in patients with sepsis,the receiver operating characteristic curve(ROC curve)was drawn and the area under the ROC curve(AUC)was calculated to evaluate the predictive value of NLR for organ dysfunction and 28-day mortality in patients with sepsis.Results A total of 714 patients with sepsis were enrolled for final statistical analysis.There was no significant difference in NLR at 24,48 and 72 hours in patients with or without organ dysfunction(such as AKI,ARDS,DIC and ALF).Logistic regression analysis showed that there was no significant difference in NLR at 24 hours with 28-day in-hospital mortality[odds ratio(OR)=1.006,95%confidence interval(95%CI)was 0.994-1.019,P=0.323].However,NLR at 48 hours and 72 hours had a significant difference with 28-day mortality(48 hours:OR=1.026,95%CI was 1.013-1.040,P=0.000;72 hours:OR=1.021,95%CI was 1.005-1.037,P=0.010),which suggested that NLR at 48 hours and 72 hours after diagnosis were independent risks factor for 28-day mortality in patients with sepsis.ROC curve showed that the AUC of NLR at 48 hours was 0.598,95%CI was 0.540-0.658,P=0.02;when the cut-off value was 10.1,the sensitivity and specificity for predicting 28-day mortality was 75.2%and 58.0%,respectively;the AUC of NLR at 72 hours was 0.595,95%CI was 0.536-0.655,P=0.03;when the cut-off value was 9.24,the sensitivity and specificity for predicting 28-day mortality was 75.3%and 59.9%,respectively.Conclusions NLR cannot predict the occurrence of AKI,ARDS,DIC and ALF in sepsis in early stage.NLR has a certain clinical value in predicting 28-day mortality in patients with sepsis,but its predictive efficiency is low.