PLR和NLR在老年脓毒症患者中的应用价值

Application Value of Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio for the Elderly Patients with Sepsis

目的探讨血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)和中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte rate,NLR)对老年脓毒症患者病情和预后的评估价值。方法选择2019年10月~2020年10月首都医科大学宣武医院急诊科收治147例老年脓毒症患者,随访30天,根据老年脓毒症患者的临床转归分为死亡组32例和生存组115例。分别比较两组老年脓毒症患者入院时白细胞计数(WBC)、PLR、NLR、降钙素原(procalcitonin,PCT)和急性生理与慢性健康状况评估(acute physiology and chronic health evaluation,APACHEⅡ)评分的区别;比较PLR、NLR与APACHEⅡ评分的相关性,同时比较PLR、NLR和PCT预测老年脓毒症患者死亡的ROC曲线下面积(AUC)的差别。结果死亡组与生存组WBC比较,差异无统计学意义(P=0.925),死亡组PCT、NLR、PLR和APACHEⅡ评分均大于生存组(P<0.05);PLR、NLR与APACHEⅡ评分均有相关性(r=0.334,0.248,P<0.01)。PLR预测死亡的AUC为0.705(95%CI:0.619~0.791),PCT的AUC为0.728(95%CI:0.634~0.822),NLR的AUC为0.716(95%CI:0.620~0.811),NLR、PLR的AUC与PCT比较,差异无统计学意义(P=0.850,0.726),NLR、PLR预测死亡的AUC均小于APACHEⅡ评分(P=0.006,0.001)。结论PLR和NLR对老年脓毒症患者的病情和预后有较好的评估价值,PLR和NLR升高提示患者病情危重,预后不佳,但预测价值仍小于APACHEⅡ评分。

Objective To investigate the value of platelet to lymphocyte ratio(PLR)and neutrophil to lymphocyte rate(NLR)in evaluating the condition and prognosis of elderly patients with sepsis.Methods Totally 147 elderly patients with sepsis were selected in the emergency department of Xuanwu Hospital of Capital Medical University from October 2019 to October 2020.They were followed up for 30 days.According to the clinical outcome,they were divided into death group(32 cases)and survival group(115 cases).The difference of white blood cell count(WBC),PLR,NLR,procalcitonin(PCT)and acute physiology and chronic health evaluation(APACHEⅡ)scores were compared between the two groups at admission;The correlation between PLR,NLR and APACHEⅡscore was compared,and the area under ROC curve(AUC)of PLR,NLR and PCT in predicting mortality in elderly patients with sepsis was compared.Results There was no significant difference in WBC between death group and survival group(P=0.925).PCT,NLR,PLR and APACHEⅡscores in death group were higher than those in survival group(P<0.05).PLR,NLR and APACHEⅡscore were correlated(r=0.334,0.248,P<0.01).The AUC of PLR was 0.705(95%CI:0.619-0.791),that of PCT was 0.728(95%CI:0.634-0.822),and that of NLR was 0.716(95%CI:0.620-0.811).There was no significant difference in AUC between NLR,PLR and PCT(P=0.850,0.726),the AUC of both NLR and PLR were less than the APACHEⅡscore.Conclusion PLR and NLR have good evaluation value for the condition and prognosis of elderly patients with sepsis.The increase of PLR and NLR indicates that the patient is in critical condition and has poor prognosis,but the predictive value is still less than the APACHEⅡscore.