中性粒细胞/淋巴细胞比值与CURB-65评分在老年社区获得性肺炎预后评价中的作用

Predictive value of neutrophil to lymphocyte ratio and CURB-65 score in elderly patients with community acquired pneumonia

目的探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与英国胸科协会改良肺炎评分(CURB-65评分)在老年社区获得性肺炎(community acquired pneumonia,CAP)预后评价中的作用。方法回顾性分析2019年1月至2020年3月安徽医科大学第三附属医院呼吸与危重症医学科收治的160例老年社区获得性肺炎患者的临床资料,根据患者30d生存情况分为存活组127例和死亡组33例。收集患者的一般临床资料和入院时或入院24 h内血常规、肝肾功能、血钠、凝血功能,C反应蛋白、降钙素原,计算NLR及CURB-65评分。通过成组t检验或X^(2)检验比较两组上述指标的差异,采用多因素Logistic回归分析筛选老年CAP患者30 d死亡的高危因素;绘制受试者工作特征曲线(receiver operating characteristic,ROC),分析NLR及CURB-65评分对死亡风险的预测价值。结果与存活组比较,死亡组患者年龄更大,合并存在神经系统疾病以及出现胸闷症状的比例较高(P<0.05)。死亡组患者淋巴细胞总数、血红蛋白及血清白蛋白水平均明显低于存活组,中性粒细胞总数、血尿素氮、D二聚体、NLR、C反应蛋白、降钙素原及CURB-65评分均明显高于存活组(均P<0.05)。多因素Logistic回归分析显示,NLR和CURB-65评分是老年CAP 30 d死亡的独立危险因素(P<0.01)。ROC生存曲线结果显示,NLR的曲线下面积(AUC)为0.823[95%CI(0.747-0.900)],截断值为8.885,评估预后的敏感度为84.8%,特异度为74.8%.NLR联合CURB-65评分的AUC为0.872[95%CI(0.801-0.942)],截断值为0.248,评估预后的敏感度为84.8%,特异度为84.3%。两者联合均较其他单独评价指标有更好的预后评估价值。结论NLR和CURB-65评分是老年CAP患者死亡的高危因素,两者联合可较好的预测老年CAP的死亡风险。

Objective To investigate the predictive value of neutrophil to lymphocyte ratio(NLR)and CURB-65 score in elderly patients with community acquired pneumonia(CAP).Methods A total of 160 elderly CAP patients who were treated in Department of Respiratory and Critical Care Medicine of the Third Affiliated Hospital of Anhui Medical University between January 2019 and March 2020 were retrospectively analyzed.According to the 30-day survival,the patients were divided into the survival group(h=127)and the death group(n=33).The general clinical data,blood routine,liver and kidney function,blood sodium,coagulation function,C-reactive protein and procalcitonin were collected,and NLR and CURB-65 scores were calculated.Pass t-test or X^(2)test was used to compare the differences of the above indexes between the two groups,and the high-risk factors of 30-day death in elderly CAP patients were screened by multivariate Logistic regression analysis;receiver operating characteristic curve(ROC)was drawn,and the predictive value of NLR and CURB-65 score on the risk of death was analyzed.Results Compared with the survival group,the patients in the death group were older and had a higher proportion of neurological diseases and chest tightness symptoms(P<0.05).The total number of lymphocytes,hemoglobin,and serum albumin were significantly decreased,and the total neutrophil count,blood urea nitrogen,D・dimer,NLR,C-reactive protein,procalcitonin and CURB-65 score were significantly increased in the death group(all P<0.05).Multivariate Logistic regression analysis showed that NLR and CURB-65 score were the independent risk factors of 30-day mortality in elderly CAP patients(P<0.01).ROC survival curve showed that the area under the curve(AUC)of NLR was 0.823[95%CI(0.747〜0.900)],the cut-off value was&885,and the sensitivity and specificity of prognosis were 84.8%and 74.8%.The AUC of NLR combined with CURB-65 score was 0.872[95%CI(0.801〜0.942)],the cut-off value was 0.248,and the sensitivity and specificity of prognosis were 84.8%and 84.3%.The combination of the two indexes had better prognostic value than other independent evaluation indexes.Conclusions NLR and CURB-65 scores are high risk factors of death in elderly CAP patients.The combination of the two indicators can better predict the risk of death.