单核细胞计数联合降钙素原对老年患者血流感染的早期预警作用

Early warning of bloodstream infection in elderly patients with monocyte countcombined with procalcitonin

目的 探索老年患者血流感染的早期预警标记物。方法 回顾性收集2018年8月~2022年8月在解放军总医院第二医疗中心就诊的209例> 65岁疑似血流感染患者的临床资料。按感染情况分为血流感染组、非血流感染组,并对此两组发热6 h、第2和14天的C反应蛋白(CRP)、降钙素原(PCT)、血常规等生物标记物的差异,采用单因素和多因素分析老年患者血流感染预警因素,并采用受试者工作特征(ROC)曲线评估其对早期预警老年患者血流感染的价值。结果 共纳入209例患者,非血流感染组142例,血流感染组67例。单因素分析中发热6 h内血流感染组中性粒细胞计数、淋巴细胞计数、单核细胞比例及计数显著低于非血流感染组,中性粒细胞比例、淋巴细胞/单核细胞(LMR)、PCT水平显著高于非血流感染组,差异有统计学意义(P<0.05)。发热第2和14天血流感染组PCT水平显著高于非血流感染组,差异有统计学意义(P<0.05),两组间其余指标差异无统计学意义(P> 0.05)。多因素logistic回归分析发现PCT(OR=6.008,95%CI=2.863~12.611,P<0.001)联合单核细胞计数(OR=4.468,95%CI=1.708~11.687,P=0.002)的曲线下面积(AUC)为0.779(0.705~0.852),P<0.001,灵敏度为0.820,特异性0.670,阳性预测值0.782,阴性预测值0.872。结论 PCT升高联合单核细胞计数下降可在发热6 h内预警老年患者血流感染。

Objective To explore early warning markers of bloodstream infection in elderly patients.Methods The clinical data of suspected bloodstream infection patients over 65 years old who were treated in the second Medical Center of PLA General Hospital from August 2018 to August 2022 were collected retrospectively.C-reactive protein(CRP),procalcitonin(PCT),blood routine and other biomarkers were compared between bloodstream infection group and non-bloodstream infection group within 6 hours,days 2 and 14 of fever.Univariate and multivariate analyses were utilized to identify early warning factors of bloodstream infection in elderly patients.Receiver operating characteristic(ROC)curve analysis evaluated its value in early warning of bloodstream infection in elderly patients.Results A total of 209 patients were included,with 142 in the non-bloodstream infection group and 67 in the bloodstream group.Univariate analysis revealed significantly lower neutrophil count,lymphocyte count,monocyte ratio and count in the bloodstream infection group within 6 hours of fever(P<0.05).Neutrophil ratio,lymphocyte monocyte(LMR)and PCT levels were significantly higher than those in non-bloodstream infection group(P<0.05).The PCT level of blood flow infection group was significantly higher than that of non-blood flow infection group on the 2nd and 14th day of fever,and there was no difference in other indexes between the two groups.Multivariate logistic regression analysis found that PCT(OR=6.008,95%CI=2.863~12.611,P<0.0001)combined with monocyte count(OR=4.468,95%CI=1.708~11.687,P=0.002)with an AUC of 0.779(0.705~0.852),P<0.001,sensitivity of 0.820,specificity of 0.670,positive predictive value of 0.782,and negative predictive value of 0.872.Conclusion The increase in PCT combined with the decrease in monocyte count predicts bloodstream infection in elderly patients within 6 hours of fever.