重症肝病合并感染患者的临床特点及NLR、MLR的预测价值

Clinical characteristics of patients with severe liver disease complicated with infection and predictive value of NLR and MLR

目的分析重症肝病合并感染患者的临床特点,探讨中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)对重症肝病合并感染患者的预测价值。方法选择2018年1月-2022年12月武汉市黄陂区人民医院收治的重症肝病患者120例,根据感染情况将患者分为感染组(n=31)和未感染组(n=89)。记录感染组患者感染部位分布情况,比较感染组与未感染组NLR、MLR,采用多因素logistic分析重症肝病患者合并感染的危险因素,并使用受试者工作特征(ROC)曲线分析NLR、MLR对重症肝病合并感染的诊断效能。结果感染组患者感染部位主要以腹腔感染、呼吸系统感染为主,分别占35.48%(11/31)、25.81%(8/31)。感染组NLR、MLR分别为(3.55±0.38)、(0.45±0.07),均明显高于未感染组(2.53±0.35)、(0.31±0.05),差异均有统计学意义(t=13.667、12.037,P均<0.001)。多因素logistic回归分析显示,年龄、Child⁃Pugh分级、糖尿病、贫血、住院时间、侵袭性操作次数、置管时间均为导致重症肝病合并感染的危险因素(P均<0.05)。ROC曲线分析,NLR+MLR联合检测曲线下面积(AUC)为0.995,95%CI为0.987~1.000,明显高于NLR(AUC=0.982,95%CI:0.963~1.000)、MLR(AUC=0.944,95%CI:0.885~0.980)单独检测。结论重症肝病合并感染患者的感染部位以腹腔感染、呼吸系统感染为主,患者感染的危险因素较多,联合检测NLR、MLR具有较高的预测价值,临床上应予以密切关注。

Objective To study the clinical characteristics of patients with severe liver disease complicated with infection and predictive value of neutrophil/lymphocyte ratio(NLR)and monocyte/lymphocyte ratio(MLR).Methods A total of 120 patients with severe liver disease admitted to Huangpi District People's Hospital from January 2018 to December 2022 were selected and divided into infected group(n=31)and uninfected group(n=89).The distribution of infection sites in the infected group was observed,and the NLR and MLR of the infected and uninfected groups were compared.Multivariate logistic analysis was used to analyze the risk factors of severe liver disease co⁃infection,and receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of NLR and MLR for severe liver disease co⁃infection.Results The infection sites in the infection group were mainly abdominal infection and respiratory system infection,accounting for 35.48%(11/31)and 25.81%(8/31);the NLR and MLR of the infected group were(3.55±0.38)and(0.45±0.07),respectively,which were significantly higher than those of the uninfected group(2.53±0.35),(0.31±0.05),the differences were statistically significant(t=13.667,12.037;all P<0.001).The multivariate logistic regression analysis showed that age,Child⁃Pugh grade,diabetes mellitus,anemia,length of hospital stay,number of invasive operations,catheterization time were all risk factors for severe liver disease combined with infection(all P<0.05);ROC curve analysis showed that the area under the cure(AUC)of the combined detection of NLR and MLR was 0.995 and 95%CI was 0.987-1.000,which were significantly higher than that of NLR(AUC=0.982,95%CI:0.963-1.000)and MLR(AUC=0.944,95%CI:0.885-0.980).Conclusions The infection site characteristics of patients with severe liver disease combined with infection were mainly abdominal infection and respiratory system infection,and there were many risk factors of infection in patients.Combined detection of NLR and MLR had high predictive value,and should be paid close attention to clinically.