血常规参数对血液透析患者发生导管相关性感染的预测价值

Predictive value of blood routine parameters for catheter-related bloodstream infection in patients undergoing hemodialysis

目的探索血常规参数对血液透析患者发生导管相关性感染的预测价值。方法回顾性选取我院肾内科病房及门诊行维持性血液透析(maintenance hemodialysis,MHD)的疑似导管相关性感染(catheter-related bloodstream infection,CRBSI)的终末期肾病(end stage renal disease,ESRD)患者107例为研究对象。获取其在发热48h内的血常规及降钙素原资料,以白细胞(white blood cell,WBC)及降钙素原为参考,评估血细胞比容(hematocrit,HCT)、平均红细胞体积(mean corpuscular volume,MCV)、平均血红蛋白含量(mean corpsular hemoglobin,MCH)、平均血红蛋白浓度(mean corpuscular hemoglobin concentration,MCHC)、红细胞分布宽度(red cell distribution width,RDW)、血小板分布宽度(platelet distribute width,PDW)、血小板压积(plateletcrit,PCT)、血小板平均体积(mean platelet volume,MPV)、大血小板比例(platelet-larger cell ratio,P-LCR%)以及衍生参数中性粒细胞绝对值/淋巴细胞绝对值(neutrophil/lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)、单核细胞/淋巴细胞比值(monocytes/lymphocyte ratio,MLR)对CRBSI发生的预测价值。结果相对于非CRBSI组,CRBSI组的WBC、降钙素原明显高于非CRBSI组(P<0.05),CRBSI组在RDW、PCT、P-LCR%、NLR、PLR、PDW上明显升高(P<0.05),而在MCV明显降低(P<0.05);WBC、降钙素原、RDW、PDW、P-LCR及NLR发生CRBSI具有一定的预测价值(P<0.05);NLR>6.78时,预测发生CRBSI的敏感度为43.32%,特异度为86.72%,P-LCR>43.67%时,预测发生CRBSI的敏感度为70.04%,特异度为66.72%,PDW超过8.84 fL时,预测发生CRBSI的敏感度为56.73%,特异度为90.03%,RDW>58.23时,预测发生CRBSI的敏感度为73.45%,特异度为66.78%;NLR、P-LCR、PDW、RDW中至少有2个超过对应的截断值时,对发生CRBSI的预测AUC为0.829,敏感度为76.67%,特异度为73.33%(P=0.001)。结论包括RDW、PDW、P-LCR以及NLR在内的4个参数对CRBSI的发生具有一定预测价值,当NLR>6.78,P-LCR>43.67,PDW>8.84 fL,RDW>58.23 fL时,满足以上4项中的至少2项对CRBSI具有较高的预测价值。

Objective To explore the predictive value of blood routine parameters for catheter-related bloodstream infection in patients undergoing hemodialysis.Methods A total of 107 patients with end-stage renal disease(ESRD)who underwent maintenance hemodialysis(MHD)and suspected catheter-related bloodstream infection(CRBSI)in the wards and outpatients in Department of Nephrology of our hospital were retrospectively selected as subjects.The blood routine and procalcitonin data were obtained within 48 h of fever.The white blood cells(WBC)and procalcitonin were used as reference.The predictive value of hematocrit(HCT),mean corpuscular volume(MCV),mean corpsularhemoglobin(MCH),mean corpsularhemoglobin concentration(MCHC),red blood cell distribution width(RDW),platelet distribution width(PDW),plateletcrit(PCT),mean platelet volume(MPV),platelet-larger cell ratio(P-LCR),and derived parameters neutrophil/lymphocyte value(NLR),platelet/lymphocyte ratio(PLR),and monocyte/lymphocyte ratio(MLR)for occurrence of CRBSI was evaluated.Results Compared with non-CRBSI group,WBC and procalcitonin in CRBSI group were significantly higher than those in non-CRBSI group(P<0.05).RDW,PCT,P-LCR%,NLR,PLR and PDW in CRBSI group were significantly increased(P<0.05),while MCV was significantly decreased(P<0.05).WBC,procalcitonin,RDW,PDW,P-LCR and NLR had certain predictive value for the occurrence of CRBSI(P<0.05).When NLR was>6.78,the sensitivity and specificity of CRBSI prediction were 43.32%and 86.72%respectively,and when P-LCR was>43.67%,the sensitivity and specificity of CRBSI prediction were 70.04%and 66.72%respetively.When PDW was>8.84 fL,the sensitivity and specificity of CRBSI prediction were 56.73%and 90.03%respectively,and when RDW was>58.23,the sensitivity and specificity of CRBSI prediction were 73.45%and 66.78%respectively.When at least two of the NLR,P-LCR,PDW and RDW exceeded the corresponding truncation value,the AUC for predicting the occurrence of CRBSI was 0.829,the sensitivity was 76.67%,and the specificity was 73.33%(P=0.001).Conclusion Four parameters,including RDW,PDW,P-LCR and NLR,have certain predictive value for the occurrence of CRBSI.In terms of NLR>6.78,P-LCR>43.67,PDW>8.84 fL,RDW>58.23 fL,at least two of the above four parameters have high predictive value for CRBSI.