血小板与淋巴细胞比值对脓毒症患者预后的评估价值

Predictive value of platelet-lymphocyte ratio in the prognosis of patients with sepsis

目的探讨血小板与淋巴细胞比值(PLR)对脓毒症患者预后的评估价值。方法选择2019年10月至2021年9月湖州市中心医院急诊科、重症医学科收治的脓毒症患者120例,依据患者28 d内的生存及死亡情况,分为生存组(76例)和死亡组(44例)。比较两组患者的临床资料,采用多因素logistic回归分析影响脓毒症患者预后的危险因素,采用ROC曲线进一步评估PLR预测脓毒症患者预后的效能,采用Spearman秩相关分析PLR、急性生理学与慢性健康评估Ⅱ(APACHEⅡ)评分与序贯性器官功能衰竭评估(SOFA)评分的相关性。结果死亡组患者的PLR、降钙素原(PCT)、血乳酸、APACHEⅡ评分以及SOFA评分均高于生存组,淋巴细胞低于生存组(均P<0.05),其他临床指标差异均无统计学意义(均P>0.05)。logistic回归分析显示,高PLR、高血乳酸、高APACHEⅡ评分以及高SOFA评分均为脓毒症预后不良的独立危险因素(均P<0.05)。ROC曲线分析结果显示,PLR对预测脓毒症患者28 d死亡率有较重要的价值,AUC为0.745,95%CI:0.645~0.845,P<0.01,最佳截断值为216.85,灵敏度为0.659,特异度为0.842。Spearman相关性分析显示,PLR与APACHEⅡ评分和SOFA评分均呈正相关(r=0.185、0.278,均P<0.05)。结论PLR升高是脓毒症患者短期死亡风险增加的独立危险因素,同时其在一定程度上表明了疾病的严重程度,对脓毒症患者的预后有一定的评估价值。

Objective To investigate the prognostic value of platelet-lymphocyte ratio(PLR)in patients with sepsis.Methods One hundred and twenty septic patients admitted in ICU of Huzhou Central Hospital from October 2019 to September 2021 were recruited in this study.Patients were divided into survival group(n=76)and fatal group(n=44)according to the 28-day survival.The clinical data were compared between the two groups.The multivariate logistic regression was used to analyze the risk factors for the prognosis of patients with sepsis.Receiver operating characteristic(ROC)curve was used to evaluate the application of PLR in the prognosis of patients with sepsis.The correlation of PCR with APACHE II and sequential organ failure assessment(SOFA)was determined by Spearman correlation analysis.Results The APACHE II score,SOFA score,LAC,PCT and PLR in the fatal group were higher than those in the survival group,lymphocytes were lower than those in the survival group(all P<0.05).Logistic regression analysis showed that high APACHE II score,high SOFA score,high LAC level and high PLR were independent risk factors for poor prognosis of septic patients(all P<0.05).The ROC curve analysis showed that the AUC of PLR in predicting 28-day mortality of patients with sepsis was 0.745(95%CI:0.645-0.845,P<0.01);taking the best cut-off point of 216.85,the sensitivity was 0.659,and the specificity was 0.842.Spearman correlation analysis displayed that PLR was positively correlated with APACHE II score and SOFA score(r=0.185,0.278,P<0.05).Conclusion Elevated PLR is an independent risk factor for increased short-term mortality in patients with sepsis,which reflects the severity and may be used for the prognosis of sepsis patients.