中性粒细胞与淋巴细胞比值、血小板计数与平均血小板体积比值对重症肺炎并发脓毒症病人预后的评估价值

Prognostic value of neutrophil to lymphocyte ratio,platelet to mean platelet volume ratio in severe pneumonia patients complicated with sepsis

目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)、血小板计数(PLT)与平均血小板体积(MPV)比值对重症肺炎(SP)并发脓毒症28d死亡的预测价值。方法选取2018年3月至2022年3月福建医科大学孟超肝胆医院收治的SP并发脓毒症病人为研究对象。记录病人的临床及实验室资料,计算NLR、PLT/MPV、24h内急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)。根据病人28d预后情况分为病死组与存活组,比较两组病人的临床资料,分析NLR、PLT/MPV与APACHEⅡ评分的相关性,应用多因素logistic回归分析影响SP并发脓毒症病人预后的独立危险因素。绘制受试者操作特征曲线(ROC曲线)评价相关指标对预后的预测价值;根据最佳截断值进行亚组分析,并绘制Kaplan-Meier生存曲线,分析SP并发脓毒症病人28d累积生存率。结果共纳入92例病人,28 d病死30例,存活62例,28 d病死率为32.6%。病死组病人的NLR为17.88(13.72,27.63),显著高于存活组NLR的11.55(8.85,15.55);病死组病人的PLT/MPV显著低于存活组PLT/MPV(均P<0.05)。与存活组比较,病死组病人的MPV、降钙素原(PCT)及APACHEⅡ评分均升高,淋巴细胞计数降低,住院天数缩短(均P<0.05)。SP并脓毒症病人NLR、PLT/MPV均与APACHEⅡ评分呈中度相关(r=0.52、-0.68,均P<0.01),logistic回归分析显示NLR、PLT/MPV、APACHEⅡ评分是影响SP并发脓毒症病人28d死亡的独立危险因素。与传统指标APACHEⅡ评分相比较,NLR、PLT/MPV对SP并脓毒症病人28d死亡预后均具有很好的预测价值[曲线下面积(AUC):0.77、0.68比0.73,Z=0.65、1.01,均P>0.05];NLR预测价值优于PLT/MPV(Z=2.18,P=0.029);三项指标联合显示出更高的预测价值(AUC=0.81)。NLR最佳截断值为11.72时,灵敏度为86.7%,特异度为53.2%;PLT/MPV最佳截断值为10.36时,灵敏度为53.3%,特异度为79.0%。与NLR<11.72组(36例)比较,NLR≥11.72组(56例)病人PCT、28d病死率上升(均P<0.01);与PLT/MPV≥10.36组(64例)比较,PLT/MPV<10.36组(28例)病人PCT、28d病死率上升(均P<0.01),各亚组间28d累积生存率差异有统计学意义(P<0.01)。结论NLR、PLT/MPV是SP并发脓毒症病人28d死亡的独立危险因素,对28d死亡风险均具有良好的预测价值,NLR预测价值优于PLT/MPV,二者联合APACHEⅡ评分预测价值更大。

Objective To explore the value of neutrophil to lymphocyte ratio(NLR),platelet(PLT)to mean platelet volume(MPV)ratio for predicting 28-day mortality in peripheral blood of severe pneumonia(SP)patients complicated with sepsis.Methods Patients with SP complicated with sepsis who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from March 2018 to March 2022 were selected as the study subjects.The clinical and laboratory data of the patients were recorded,and NLR,PLT/MPV,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 hours were calculated.According to the 28-day prognosis,the patients were assigned into death group and survival group.The clinical data of the two groups were compared,and the correlation between NLR,PLT/MPV and APACHEⅡscore was analyzed,and Multivariate Logistic regression analysis was used to analyze the independent risk factors influencing the prognosis of SP patients complicated with sepsis.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of relevant indicators for prognosis;subgroup analysis was performed according to the best cut-off value,and Kaplan-Meier survival curve was drawn to analyze the 28-day cumulative survival rate of patients with SP complicated with sepsis.Results A total of 92 patients were included.Among them,30 patients died on the 28th day,and 62 survived.The 28-day mortality rate was 32.6%.The NLR of patients in the death group was 17.88(13.72,27.63),which was significantly higher than that of the survival group 11.55(8.85,15.55);and the PLT/MPV of patients in the death group was significantly lower than that of the survival group,and the above indexes were compared between the two groups,and the differences were statistically significant(all P<0.05).Compared with the survival group,the levels of MPV,procalcitonin(PCT)and APACHEⅡscores of the patients in the death group were significantly increased,the levels of lymphocyte counts were significantly decreased,and the length of hospital stay was significantly shortened(all P<0.05).The levels of NLR,PLT/MPV in patients with SP complicated with sepsis were moderately correlated with APACHEⅡscore(r=0.52,−0.68,all P<0.01).Logistic regression analysis showed that NLR,PLT/MPV and APACHEⅡscore were independent risk factors affecting the 28-day death of SP patients complicated with sepsis.ROC curve analysis showed that NLR and PLT/MPV had good predictive value for 28-day mortality in SP patients complicated sepsis compared with the traditional index APACHEⅡscore[area under the curve(AUC):0.77,0.68 vs.0.73,Z=0.65,1.01,all P<0.05];the predictive value of NLR was better than that of PLT/MPV(Z=2.18,P=0.029);the three indicators combined showed higher predictive value(AUC=0.81).When the best cut-off value of NLR was 11.72,the sensitivity was 86.7%and the specificity was 53.2%;when the best cut-off value of PLT/MPV was 10.36,the sensitivity was 53.3%and the specificity was 79.0%.Subgroup analysis showed that compared with the NLR<11.72 group(36 cases),the PCT and 28-day mortality of patients in the NLR≥11.72 group(56 cases)increased significantly(both P<0.01);compared with the PLT/MPV≥10.36 group(64 cases),the PCT and 28-day mortality of patients in the PLT/MPV<10.36 group(28 cases)increased significantly(all P<0.01),and the 28-day cumulative survival rates were different among subgroups(P<0.01).Conclusions NLR and PLT/MPV are independent risk factors for 28-day death in SP patients complicated with sepsis,and both have good predictive value for 28-day mortality risk.The predictive value of NLR is better than that of PLT/MPV,and the two indicators combined with APACHEⅡscore have greater predictive value.