血常规及其衍生比值在继发性噬血细胞综合征短期预后中的预测效能

Predictive value of blood routine and its derived indexes in short-term prognosis of secondary hemophagocytic lymphohistiocytosis

目的 研究继发性噬血细胞综合征(secondary hemophagocytic lymphohistiocytosis, sHLH)患者血常规及其衍生比值对早期死亡的预测价值。方法 选取中国人民解放军空军军医大学第一附属医院急诊科2017年7月1日至2022年7月1日的sHLH患者共96例,根据28 d预后分为存活组和死亡组,对急诊第一时间接诊后的血常规和生化指标进行单因素分析,对单因素分析差异有统计学意义的指标进行Cox回归、K-M生存曲线及预后相关性热图分析,最后对筛选出有统计学意义的指标进行受试者工作特征(ROC)曲线分析,评估其预测价值。结果 96例患者根据预后分为存活组(n=49)和死亡组(n=47),对相关指标进行单因素分析显示,两组血白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)、红细胞分布宽度(RDW)与血小板计数比值(RPR)和凝血酶原时间(PT)差异有统计学意义(P<0.05)。Cox回归、K-M生存曲线及预后相关性热图分析提示,血WBC、PLT和RPR可能是影响sHLH预后的指标。sHLH患者预后的ROC曲线分析显示,三者预测效能良好,其中RPR曲线下面积(AUC)最大(0.79)。结论 血WBC、PLT和RPR是预测sHLH预后的相关因素,尤其是RPR,可用于临床判断sHLH早期死亡风险,指导急诊科医生分层治疗。

Objective To study the predictive value of blood routine and its derived indexes in early death of the patients with secondary hemophagocytic lymphohistiocytosis(sHLH). Methods A total of 96 patients with sHLH admitted in our department from July 1st, 2017 to July 1st, 2022 were enrolled and divided into survival group and death group according to the 28-day prognosis. The blood routine and biochemical indexes after the first reception were analyzed by univariate analysis, and the indicators with statistically significant differences were further analyzed by Cox regression, K-M survival curve, and prognostic correlation heatmap. ROC curve was adopted to evaluate the predictive values of the screened indicators. Results According to the prognosis, 96 patients were divided into survival group(49 cases) and death group(47 cases). Univariate analysis of blood routine and collected indexes showed that WBC, RBC, PT, RDW to platelet ratio(RPR), Hb and PLT were significantly different between the two groups(P<0.05). Cox regression, K-M survival curve, and heatmap analysis suggested that WBC, PLT and RPR may be prognostic factors of sHLH. Moreover, ROC curves of the prognosis of sHLH patients showed that these three factors had good predictive efficacy, and the area under the ROC curve(AUC) of RPR was the largest(0.79). Conclusions WBC, PLT and RPR are the prognostic factors of sHLH, especially RPR, which can be used for clinical judgement of the early death risk in patients with sHLH and the guidance on the stratified treatment for emergency physician.