外周血PCT、D-二聚体、NLR、SII对脓毒症患者预后的预测价值分析

Analysis of Predictive Value of Peripheral Blood PCT,D-dimer,NLR and SII on the Prognosis in Patients with Sepsis

目的:探究外周血降钙素(PCT)、D-二聚体(D-D)、中性粒细胞数与淋巴细胞数比值(NLR)、系统免疫炎症指数(SII)对脓毒症患者预后的预测价值。方法:回顾性分析吉安市中心人民医院2019年6月—2023年6月收治的82例脓毒症患者临床资料,依据预后是否发生休克分为脓毒症未休克组(n=51)、脓毒性休克组(n=31)。比较两组基本资料、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、血清PCT、D-D、NLR、SII水平差异,以logistic回归分析脓毒性休克的危险因素,并采用受试者操作特征(ROC)曲线描述上述指标应用于脓毒症患者预后的预测效能。结果:脓毒症未休克组外周血NLR、SII及PCT与D-D水平、APACHEⅡ及SOFA评分均低于脓毒性休克组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示SOFA评分[OR=1.244,95%CI(1.020,1.516),P=0.031]、APACHEⅡ评分[OR=2.404,95%CI(1.359,4.252),P=0.003]、PCT[OR=2.492,95%CI(1.428,4.348),P=0.001]、D-D[OR=2.073,95%CI(1.548,2.776),P<0.001]、NLR[OR=1.053,95%CI(1.015,1.093),P=0.005]、SII[OR=2.370,95%CI(1.249,4.499),P=0.009]为脓毒性休克的独立危险因素。血清PCT、D-D水平及NLR、SII预测脓毒症患者预后的截断值依次为10.42μg/mL、5.07 mg/L、11.94、951.84,联合预测ROC曲线下面积(AUC)为0.984[95%CI(0.927,0.999)],敏感度为93.55%,特异度为98.04%。结论:外周血PCT、D-D、NLR、SII与脓毒症预后情况联系紧密,可通过早期联合检测预警,针对性采取防治工作。

Objective:To explore the predictive value of peripheral blood procalcitonin(PCT),D-dimer(D-D),neutrophil-to-lymphocyte ratio(NLR)and systemic immune-inflammation index(SII)on the prognosis in patients with sepsis.Method:The clinical data of 82 patients with sepsis in Ji’an Central People's Hospital from June 2019 to June 2023 were retrospectively analyzed.According to the presence or absence of shock,they were divided into septic non-shock group(n=51)and septic shock group(n=31).The basic data,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,sequential organ failure assessment(SOFA)and levels of serum PCT,D-D,NLR and SII were compared between both groups of patients.The risk factors of septic shock were analyzed by logistic regression analysis,and receiver operating characteristic(ROC)curve was adopted to describe the predictive efficiency of the above indicators on the prognosis in patients with sepsis.Result:The levels of NLR,SII,PCT and D-D,APACHEⅡscore and SOFA in septic non-shock group were lower than those in septic shock group,the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that SOFA score[OR=1.244,95%CI(1.020,1.516),P=0.031],APACHEⅡscore[OR=2.404,95%CI(1.359,4.252),P=0.003],PCT[OR=2.492,95%CI(1.428,4.348),P=0.001],D-D[OR=2.073,95%CI(1.548,2.776),P<0.001],NLR[OR=1.053,95%CI(1.015,1.093),P=0.005]and SII[OR=2.370,95%CI(1.249,4.499),P=0.009]were independent risk factors for septic shock.The cut-off values of serum PCT,D-D,NLR and SII for predicting the prognosis in patients with sepsis were 10.42μg/mL,5.07 mg/L,11.94 and 951.84 respectively.The combined prediction ROC area under the curve(AUC)was 0.984[95%CI(0.927,0.999)],with a sensitivity of 93.55%and a specificity of 98.04%.Conclusion:Peripheral blood PCT,D-D,NLR and SII are closely related to the prognosis of sepsis.Early combined detection and early warning can be used to take targeted prevention and treatment.