BLA、PCT联合NLR在创伤后脓毒症患者预后中的预测价值

The Predictive Value of BLA,PCT Combined With NLR in the Prognosis of Post-Traumatic Sepsis Patients

目的 探讨早期血乳酸(blood lactic acid,BLA)、降钙素原(procalcitonin,PCT)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte,NLR)联合检测对创伤后脓毒症患者早期预后的预测价值。方法 选取2022年2月—2023年2月厦门市苏颂医院收治的创伤后脓毒症患者90例作为研究对象,依据28 d内患者生存情况将其分为死亡组与存活组。收集患者的基本临床资料,比较两组BLA、PCT、NLR水平差异,采用Logistic回归分析影响创伤后脓毒症患者早期预后的危险因素,并绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线分析BLA、PCT、NLR单一及联合检测对创伤后脓毒症患者早期预后的预测价值。结果 本研究死亡组25例,存活组65例,存活率为72.22%。死亡组与存活组的年龄、损伤严重程度评分(injury severity score,ISS)、BLA、PCT、NLR、急性生理与慢性健康评分Ⅱ(acute physiology and chronic health score,APACHEⅡ)评分、呼吸机使用时间等比较,差异有统计学意义(P <0.05)。经Logistic分析发现,BLA(OR=1.392)、PCT(OR=1.347)、NLR(OR=1.462)均为创伤后脓毒症患者死亡的危险因素(P <0.05)。BLA、PCT、NLR诊断创伤后脓毒症死亡患者的曲线下面积(area under curve,AUC)分别为0.765、0.790、0.748;BLA、PCT、NLR三者联合诊断创伤后脓毒症死亡患者的AUC为0.908(0.828~0.959),敏感度、特异度分别为0.880、0.892(P <0.05),三者联合诊断的效能均较BLA、PCT、NLR单一指标更高(Z=2.351、2.342、2.848,P=0.019、0.019、0.004)。结论 创伤后脓毒症患者BLA、PCT、NLR水平均升高,三者联合检测对早期创伤后脓毒症患者预后具有更好的预测价值。

Objective To explore the predictive value of combined detection of early blood lactic acid(BLA),procalcitonin(PCT)and neutrophil/lymphocyte ratio(NLR)in the early prognosis of patients with post-traumatic sepsis.Methods A total of 90 patients with post-traumatic sepsis admitted to Xiamen Susong Hospital from February 2022 to February 2023 were selected as the study subjects.According to the survival of patients within 28 days,they were divided into death group and survival group.The basic clinical data of the patients were collected,and the differences in BLA,PCT and NLR levels between the two groups were compared.Logistic regression analysis was used to analyze the risk factors affecting the early prognosis of patients with post-traumatic sepsis,and receiver operating characteristic curve(ROC)curve was drawn to analyze the predictive value of single and combined detection of BLA,PCT and NLR for the early prognosis of patients with post-traumatic sepsis.Results In this study,there were 25 cases in the death group and 65 cases in the survival group.The survival rate was 72.22%.There were significant differences in age,injury severity score(ISS),BLA,PCT,NLR,acute physiology and chronic health scoreⅡ(APACHEⅡ)score and ventilator use time between the death group and the survival group(P<0.05).Logistic analysis showed that BLA(OR=1.392),PCT(OR=1.347)and NLR(OR=1.462)were all risk factors for death in patients with post-traumatic sepsis(P<0.05).The area under curve(AUC)of BLA,PCT and NLR in the diagnosis of sepsis death after trauma were 0.765,0.790 and 0.748.The AUC of the combined diagnosis of BLA,PCT,and NLR in patients who died of post-traumatic sepsis was 0.908(0.828-0.959),and the sensitivity and specificity were 0.880 and 0.892,respectively(P<0.05).The efficacy of the combined diagnosis of the three was higher than that of the single index of BLA,PCT,and NLR(Z=2.351,2.342,2.848,P=0.019,0.019,0.004).Conclusion The levels of BLA,PCT and NLR in patients with post-traumatic sepsis were increased,and the combined detection of the three had better predictive value for the prognosis of patients with early post-traumatic sepsis.