NLR、MPR对感染性休克患者严重程度及死亡预测价值研究

The Study of MPR and NLR for the Severity and Mortality of Septic Shock Patients

目的 探讨中性粒细胞/淋巴细胞(NLR)、平均血小板体积/血小板计数(MPR)对感染性休克患者严重程度及死亡预测价值研究。方法 选取2018年1月至2020年12月于我院治疗的感染性休克患者104例为研究对象,根据患者ICU住院期间预后情况分为死亡组(n=43)和治愈组(n=61)。收集两组患者临床资料,计算患者基线时急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHE II)和序贯性脏器衰竭评价评分(sequential 0rgan failure assessment, SOFA),并进行统计分析。结果 两组患者性别、年龄、入院时间、基础疾病、入院当天呼吸频率、血压、体温、心率、基础疾病等一般资料差异无统计学意义(P>0.05)。死亡组患者与治愈组患者WBC、MPV、PLT、LYM、NEU差异无统计学意义(P>0.05),死亡组患者NLR、MPR、APACHE II评分、SOFA评分大于治愈组,差异有统计学意义(P<0.05)。相关性分析结果显示NLR与APACHE II评分(r=0.879,P䥺Symbol|@@0.001)、SOFA评分(r=0.751,P䥺Symbol|@@0.001)呈正比,MPR与APACHE II评分(r=0.563,P䥺Symbol|@@0.001)、SOFA评分(r=0.832,P䥺Symbol|@@0.001)呈正比。Logistic回归分析结果显示NLR(OR=2.316,P=0.023)、MPR(OR=2.054,P=0.029)与APACHE II评分(OR=2.363,P=0.014)、SOFA评分(OR=2.160,P=0.024)是感染性休克患者死亡的危险因素。NLR、MPR诊断感染性休克患者死亡的截断值分别为25.34、0.38,灵敏度分别为0.697、0.720,特异性分别为0.672、0.688,ROC曲线下面积为0.682、0.701,而两者联合诊断感染性休克患者死亡的灵敏度为0.814,特异性为0.655,ROC曲线下面积为0.721。结论 NLR、MPR在感染性休克患者数值增加,是感染性休克死亡的为危险因素,且对于感染性休克的死亡有一定的预测价值,具有一定的临床意义。

Objective To study the severity and mortality of septic shock patients by neutrophil/lymphocyte Rate(NLR), mean platelet volume/platelet count rate(MPR).Methods A total of 104 patients with septic shock treated in our hospital from January, 2018 to December, 2020 were selected as the study objects. According to the prognosis of patients, a death group(n=43) and a cure group(n=61) were collected. The acute physiological and chronic health evaluation at baseline was calculated, APACHE II and sequential organ failure evaluation(SOFA) were evaluated and analyzed statistically.Results There was no significant difference in general data of sex, age, admission time, basic disease, respiratory frequency, blood pressure, temperature and heart rate between the two groups(P>0.05). There was no significant difference in WBC, MPV, PLT, lym and neu between the death group and the cured group(P>0.05). NLR, MPR, APACHE II and SOFA scores in the death group were higher than those in the cured group(P<0.05). Correlation analysis showed that NLR was positively correlated with APACHE II score(r=0.879, P>Symbol|@@0.001) and SOFA score(r=0.751, P>Symbol|@@0.001), MPR were positively correlated with APACHE II score(r=0.563, P<Symbol|@@0.001) and SOFA score(r=0.832, P<Symbol|@@0.001). Logistic regression analysis showed that NLR(OR=2.316, P=0.023), MPR(OR=2.054, P=0.029), APACHE II score(OR=2.363, P=0.014) and SOFA score(OR=2.160, P=0.024) were risk factors for death in patients with septic shock. The cut-off values of NLR and MPR for the diagnosis of death in septic shock patients were 25.34 and 0.38, respectively, with the sensitivity of 0.697 and 0.720 respectively, the specificity of 0.672 and 0.688, respectively. The area under ROC curve were 0.682 and 0.701, respectively. The sensitivity, specificity and area under ROC curve of NLR and MPR for the diagnosis of death in septic shock patients were 0.814, 0.655 and 0.721, respectively.Conclusion The increase of NLR and MPR in patients with septic shock is a risk factor for septic shock death, and has a certain predictive value for the mortality of septic shock, with a certain clinical significance.