中性粒细胞/前白蛋白值对静脉置管引起脓毒症患者进展为慢重症的预测价值

Predictive value of neutrophils to prealbumin ratio in the progression of chronic critical illness in patients with sepsis caused by intravenous catheterization

目的:探究中性粒细胞/前白蛋白值(neutrophils to prealbumin ratio,NPR)对静脉置管引起脓毒症患者进展为慢重症(chronic critical illness,CCI)的预测价值。方法:回顾性选取2020年1月至2021年10月海南医学院第二附属医院内科重症监护病房接收的静脉置管引起的导管相关性脓毒症(catheter-related sepsis,CRS)患者158例,根据患者是否发生CCI分为两组。进展为CCI患者共75例,称为CCI组;未进展为CCI患者共83例,称为对照组。收集并分析两组患者临床资料。结果:Logistic回归分析显示:高龄、高改良版危重症营养风险(Modified Nutrition Risk in the CriticallyⅢ,mNUTRIC)/急性生理学与慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)、血清肌酐(serum creatinine,SCr)高表达及NPR偏高均为脓毒症患者进展为CCI的独立危险因素(均P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示:NPR单因素预测CCI的曲线下面积(area under the curve,AUC)为0.843,灵敏度、特异度分别为72.90%、90.36%,年龄、mNUTRIC、APACHEⅡ评分、SCr、NPR也对脓毒症患者是否进展为CCI具有一定的预测价值(均P<0.05)。以上指标联合预测CCI的AUC最高,为0.963。结论:NRR对静脉置管引起脓毒症患者进展为CCI具有较好的预测价值,可协助临床预测、诊治CCI。同时脓毒症患者预后情况还与患者年龄、疾病发展程度等因素有关。

Objective:To explore the predictive value of neutrophils to prealbumin ratio(NPR) in the progression of chronic critical illness(CCI) in patients with sepsis caused by intravenous catheterization.Methods:From January2020 to October 2021,a total of 158 patients with catheter-related sepsis(CRS) caused by venous catheterization admitted to the Intensive Care Unit of Internal Medicine of Second Affiliated Hospital of Hainan Medical College were retrospectively selected.They were divided into 2 groups according to whether the patients had CCI or not.Seventy-five patients who progressed to CCI were considered as a CCI group,and 83 patients who did not progress to CCI were considered as a control group.The clinical data of the 2 groups of patients were collected and analyzed.Results:Logistic regression analysis showed that advanced age,high the Modified Nutrition Risk in the Critically Ill(mNUTRIC)/Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score,high expression of serum creatinine(SCr),and high NPR were independent risk factors for the progression of CCI in sepsis patients(all P<0.05).Receiver operating characteristic(ROC) curve analysis showed that the area under the curve(AUC) of NPR univariate predicting CCI was 0.843,and the sensitivity and specificity were 72.90% and90.36%,respectively.Age,mNUTRIC,APACHE Ⅱ score,SCr,and NPR also had certain effects on whether sepsis patients progressed to CCI(all P<0.05).The AUC of combination of the above indicators predicted CCI was the highest,which was 0.963.Conclusion:NRR has a good predictive value for the progression of CCI in patients with sepsis caused by venous catheterization,and can assist in clinical prediction,diagnosis,and treatment of CCI.At the same time,the prognosis of patients with sepsis is also related to the age of the patient,the degree of disease development,and other factors.