中性粒细胞计数与淋巴细胞和血小板计数比值联合血乳酸对多发伤患者并发AKI预测价值研究

The value of the ratio of neutrophil count to lymphocyte count and platelet count combined with blood lactic acid in predicting AKI in patients with multiple injuries

目的:探讨中性粒细胞计数与淋巴细胞和血小板计数比值(N/LPR)联合血乳酸对多发伤患者并发急性肾功能损伤(acute kidney injury,AKI)的预测价值。方法:回顾性分析2021年2月—2023年10月南宁市第八人民医院急诊科收治的87例重型多发伤患者临床资料,根据患者住院期间是否发生AKI,分为AKI组及非AKI组,对比两组患者入院时创伤严重度评分、中性粒细胞计数、淋巴细胞计数、血小板计数、血清乳酸等指标,采用logistic回归筛选患者发生AKI的影响因素,ROC曲线分析N/LPR、血乳酸及两者联合对AKI发生的预测价值。结果:治疗前两组患者年龄、性别、合并疾病、入院白细胞计数、血红蛋白计数、血清肌酐进行比较,均差异无统计学意义(均P>0.05);AKI组ISS评分、N/LPR、血乳酸、C反应蛋白高于非AKI组,差异有统计学意义(均P<0.05);入院平均动脉压低于非AKI组,差异有统计学意义(P<0.05);logistics回归分析显示,N/LPR和血乳酸是多发伤患者发生AKI的独立危险因素(P<0.05);ROC分析显示,以N/LPR>9.06判断多发伤患者发生AKI的灵敏度为86.7%,特异度为62.9%,曲线下面积为0.726;以血乳酸>2.58 mmol/L判断多发伤患者发生AKI的灵敏度为90.7%,特异度为54.2%,曲线下面积为0.738;两者联合,判断多发伤患者发生AKI的灵敏度为86.7%,特异度为73.6%,曲线下面积为0.869。结论:N/LPR和血乳酸升高是影响多发伤患者发生AKI的独立危险因素,N/LPR和血乳酸可有效预测多发伤患者并发AKI,对临床预防和治疗AKI发生具有重要临床意义。

Objective To investigate the value of neutrophil count to lymphocyte and platelet count ratio(N/LPR)combined with blood lactic acid in predicting acute kidney injury(AKI)in patients with multiple injuries.Methods The clinical data of 87 patients with severe multiple injuries admitted to the emergency Department of the Eighth People's Hospital of Nanning,Guangxi from February 2021 to October 2023 were retrospectively analyzed.According to whether AKI occurred during hospitalization,the patients were divided into AKI group and non-AKI group.Trauma severity score,neutrophil count,lymphocyte count,platelet count,serum lactic acid and other indicators were compared between the two groups at admission.logistic regression was used to screen the factors affecting the occurrence of AKI in patients.ROC curve was used to analyze the predictive value of N/LPR,blood lactic acid and their combination on the occurrence of AKI.Results Before treatment,there were no significant differences in age,gender,disease,white blood cell count,hemoglobin count and serum creatinine between the two groups(all P>0.05).ISS score,ratio of neutrophil count to lymphocyte and platelet count,blood lactic acid and C-reactive protein in AKI group were higher than those in non-AKI group(all P<0.05).The mean arterial pressure on admission was lower than that in non-AKI group(P<0.05).logistics regression analysis showed that N/LPR and blood lactic acid were independent risk factors for AKI in patients with multiple injuries(P<0.05).ROC analysis showed that with N/LPR>9.06,the AUC of AKI occurance in patients with multiple injuries was 0.726 and the sensitivity and specificity were 86.7%,62.9%respectively.With blood lactic acid>2.58 mmol/L,the sensitivity and specificity of AKI in patients with multiple injuries were 90.7%,54.2%,and the AUC was 0.738.Combined both indicators,the AUC of AKI in patients with multiple injuries was 0.869 and the sensitivity and specificity were 86.7%,73.6%respectively.Conclusion Elevated N/LPR and blood lactic acid are independent risk factors for AKI in patients with multiple injuries.N/LPR and blood lactic acid can effectively predict AKI in patients with multiple injuries,which is of great clinical significance for clinical prevention and treatment of AKI.