中性粒细胞与淋巴细胞比率、血小板计数联合D-二聚体对重症肺炎合并脓毒症患儿预后的预测价值

Predictive value of neutrophil to lymphocyte ratio and platelet count combined with D-dimer in the prognosis of children with severe pneumonia complicated with sepsis

目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房(emergency intensive care unit,EICU)2018年1月~2023年1月收治的310例重症肺炎合并脓毒症患儿的临床资料,对所有患儿治疗出院后进行门诊复查或电话随访并根据相关标准对患儿预后进行评估,根据预后情况分为预后良好组(n=198)和预后不良组(n=112)。利用医院电子病历系统,收集全部患儿年龄、性别等基本临床资料,记录入院时患儿早期预警评分[慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)],并收集诊断患儿入院24 h内的实验室指标。采用Logistic回归分析肺炎合并脓毒症患儿发生预后不良的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLT计数、D-D预测重症肺炎合并脓毒症患儿预后的灵敏度、特异度、准确度。结果两组患儿年龄、性别差异无统计学意义(P>0.05)。预后不良组APACHEⅡ、SOFA评分显著高于预后良好组(P<0.05)。预后良好组NLR、D-D水平均低于预后不良组,PLT计数水平高于预后不良组(P<0.05)。将单因素分析的结果中P≤0.05的变量纳入多因素Logistic回归确定影响预后的独立危险因素。调整年龄、性别、APACHEⅡ评分等混杂因素,连续变量原值收入,结果表明,NLR、D-D水平是预后的保护因素(OR<1,P<0.05),PLT计数水平是预后的危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,三项指标联合预测的曲线下面积(area under the curve,AUC)为0.949,灵敏度为94.95%,特异度为82.14%,准确度为90.32%,三者联合预测效能价值高。结论重症肺炎合并脓毒症患儿的外周血NLR、PLT计数、D-D水平显著升高,三项联合检测在预测患儿28 d后的预后中具有重要的价值。

Objective To investigate the prognosticative value of neutrophil to lymphocyte ratio(NLR)and platelet(PLT)combined with D-dimer(D-D)in children with severe pneumonia complicated with sepsis.Methods The clinical data of 310 children with severe pneumonia complicated with sepsis admitted to the emergency intensive care unit(EICU)of Beijing Children's Hospital,Capital Medical University from January 2018 to January 2023 were reviewed.All the children were followed up by outpatient review or telephone after discharge,and the prognosis of the children was evaluated according to relevant criteria.They were divided into good prognosis group(n=198)and bad prognosis group(n=112).The hospital electronic medical record information system was used to collect the basic clinical data such as age and gender of all the children,record the early warning score[chronic health status scoreⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)]of the children at admission,and collect the laboratory indicators within 24 h of diagnosis of sepsis.Logistic regression was used to analyze the related influencing factors of poor prognosis in children with pneumonia complicated with sepsis,and receiver operating curve(ROC)was used to analyze the sensitivity,specificity and accuracy of NLR,PLT count and D-D in predicting the prognosis of children with severe pneumonia complicated with sepsis.Results There was no significant difference in age and gender between the two groups(P<0.05).APACHEII and SOFA scores in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).The levels of NLR and D-D in the good prognosis group were significantly lower than those in the poor prognosis group,and the expression level of PLT was higher than that in the poor prognosis group(P<0.05).The variables with P≤0.05 in univariate analysis were included in multivariate Logistic regression to determine the independent risk factors for prognosis.Adjusted for confounding factors such as age,sex,APACHE II score,and continuous variables,NLR and d-dimer levels were protective factors for prognosis(OR<1,P<0.05),the expression level of PLT was a risk factor for prognosis(OR>1,P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC),sensitivity,specificity and accuracy were 0.949,94.95%,82.14%and 90.32%,respectively.Conclusions The NLR,PLT count and D-D in peripheral blood of children with severe pneumonia complicated with sepsis are significantly increased,and the three combined tests are of great value in predicting the prognosis of children.