中性粒细胞/淋巴细胞比值对老年脓毒症患者进展为慢重症的预测价值

Predictive value of neutrophil to lymphocyte ratio in the progression of sepsis to chronic critical illness in elderly patients

目的探讨中性粒细胞/淋巴细胞比值(NLR)对老年脓毒症患者进展为慢重症(CCI)的预测价值。方法纳入2019年8月至2021年4月解放军南部战区总医院内科重症监护病房(MICU)连续收治的住院时间≥24 h、年龄>60岁的脓毒症患者。收集患者入科1、4、7 d的中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、NLR等外周血细胞数据。根据是否进展为CCI〔CCI定义为MICU住院时间≥14 d且持续器官功能障碍(序贯器官衰竭评分,SOFA≥2分)〕将患者分为CCI组和非CCI组,比较两组各指标的差异;Logistic回归分析CCI发生的危险因素;绘制受试者工作特征曲线(ROC曲线)以评价NLR对老年脓毒症进展为CCI的预测价值。结果①共纳入老年脓毒症患者103例,其中16例(15.5%)在入MICU 2周内死亡,46例(44.7%)进展为CCI,41例(39.8%)未进展为CCI。②两组间比较,CCI组7 d时NEU显著高于非CCI组〔×10^(9)/L:9.80(6.72,16.80)比6.66(5.14,9.29),P<0.01〕,LYM显著低于非CCI组〔×10^(9)/L:0.77(0.46,1.20)比1.00(0.86,1.48),P<0.05〕;4 d和7 d时NLR均显著高于非CCI组〔4 d:12.85(6.56,17.56)比8.26(5.34,13.17),7 d:13.76(6.97,23.66)比6.14(4.04,8.84),均P<0.05〕。组内不同时间点比较,非CCI组随时间延长NEU、NLR呈下降趋势,LYM呈升高趋势(χ^(2)值分别为10.216、28.343、7.189,均P<0.05),并趋于正常;而CCI组各时间点NEU、LYM、NLR无明显变化(χ^(2)值分别为0.798、4.478、5.783,均P>0.05)。③多因素Logistic回归分析显示,7 d时NLR是老年脓毒症患者进展为CCI的独立危险因素〔优势比(OR)=1.155,P=0.005〕。④ROC曲线分析显示,7 d时NLR预测老年脓毒症患者进展为CCI的曲线下面积(AUC)为0.775,95%可信区间(95%CI)为0.670~0.860,P<0.01;其最佳截断值为9.25时,敏感度为69.57%,特异度为80.56%。结论动态监测NLR有助于判断老年脓毒症患者的进展,病程7 d时NLR对预测CCI的发生具有一定价值。

Objective To explore the predictive value of neutrophil to lymphocyte ratio(NLR)in the progression of sepsis to chronic critical illness(CCI)in elderly patients.Methods Patients with sepsis who were hospitalized more than 24 hours and older than 60 years old admitted to the department of medical intensive care unit(MICU)of General Hospital of Southern Theatre Command from August 2019 to April 2021 were enrolled.The neutrophil count(NEU),lymphocyte count(LYM)and NLR of peripheral blood cells were recorded on the 1st,4th and 7th day after admission.Patients were divided into the CCI group and the non-CCI group according to whether they progressed to CCI,and differences between the two groups were compared.The CCI was defined as a MICU length of stay(LOS)≥14 days and persistent organ dysfunction[sequential organ failure assessment(SOFA)score≥2].Logistic regression analysis was performed to evaluate the risk factors for predicting CCI.The receiver operator characteristic curve(ROC curve)was plotted for evaluating the predictive value of NLR in the progression of sepsis to CCI in elderly patients.Results①Among 103 sepsis patients enrolled,16(15.5%)died within 2 weeks of admission to the MICU,46(44.7%)developed CCI,and 41(39.8%)were non-CCI.②Compared between the two groups,the NEU of CCI group on day 7 was significantly higher than that of non-CCI group[×10^(9)/L:9.80(6.72,16.80)vs.6.66(5.14,9.29),P<0.01],LYM was significantly lower than that of non-CCI group[×10^(9)/L:0.77(0.46,1.20)vs.1.00(0.86,1.48),P<0.05],and NLR on day 4 and day 7 were significantly higher than those of non-CCI group[12.85(6.56,17.56)vs.8.26(5.34,13.17),13.76(6.97,23.66)vs.6.14(4.04,8.84),both P<0.05].Compared with different time points in the same group,NEU and NLR decreased gradually and LYM increased gradually in non-CCI group(χ^(2) values were 10.216,28.343,7.189,respectively,all P<0.05),which tended to be normal.There were no significant differences in NEU,LYM and NLR of CCI group at each time point(χ^(2) values were 0.798,4.478,5.783,respectively,all P>0.05).③Multivariate Logistic regression analysis showed that NLR on day 7 was an independent risk factor for sepsis progression to CCI[odds ratio(OR)=1.155,P=0.005].④ROC curve analysis showed that the area under the curve(AUC)of NLR predicting the sepsis progression to CCI on day 7 was 0.775,and the 95%confidence interval(95%CI)was 0.670-0.860,P<0.01;when the cut-off value was 9.25,the sensitivity was 69.57%and the specificity was 80.56%.Conclusion Dynamic monitoring of NLR is helpful to determine the progress of sepsis in elderly patients,NLR on day 7 has a certain predictive value for the occurrence of CCI.