高危患者肺炎严重度指数联合中性粒细胞/淋巴细胞比值在ICU呼吸道感染患者病情评估中的应用价值

Application value of pneumonia severity index in high risk patients combined with neutrophil/lymphocyte ratio in condition evaluation of patients with respiratory tract infection in ICU

目的研究高危患者肺炎严重度指数(PSI-HR)、中性粒细胞与淋巴细胞比值(NLR)在ICU呼吸道感染患者病情评估中的应用价值。方法回顾性分析2020年1月至2023年7月在黄山首康医院重症医学科住院的下呼吸道感染患者临床资料。根据ICU转归,将患者分为好转组(n=77)和预后不良组(n=25),绘制受试者工作特征(ROC)曲线分析PSI-HR评分联合NLR、NLR、PSI-HR评分、PSI-HR分级及PSI分级对下呼吸道感染患者预后的评估价值。结果PSI不同分级患者病死率分别为5级40.00%(16/40)、4级18.75%(6/32)、3级22.22%(2/9)、2级4.76%(1/21),PSI分级与患者病死率无明显相关性(r=0.911,P=0.089)。PSI-HR不同分级病死率分别为6级75.00%(3/4)、5级46.67%(7/15)、4级28.57%(6/21)、3级17.24%(5/29)、2级12.12%(4/33),PSI-HR分级与患者病死率呈正相关(r=0.955,P=0.011)。预测下呼吸道感染患者预后的ROC曲线下面积(AUC)由大到小依次为PSI-HR评分联合NLR(AUC=0.828,95%CI:0.717~0.938,P<0.05),NLR(AUC=0.754,95%CI:0.637~0.871,P<0.05),PSI-HR评分(AUC=0.744,95%CI:0.636~0.852,P<0.05),PSI-HR分级(AUC=0.706,95%CI:0.584~0.829,P<0.05),PSI分级(AUC=0.695,95%CI:0.582~0.807,P<0.05)。结论PSI-HR分级与下呼吸道感染患者病死率有较好的相关性,PSI-HR分级联合NLR预测ICU呼吸道感染患者预后的效能优于单一指标。

Objective To study the application value of pneumonia severity index high-risk score(PSI-HR)in high risk patients and neutrophil-to-lymphocyte ratio(NLR)in the condition evaluation of the patients with respiratory tract infection in ICU.Methods The clinical data of the patients with lower respiratory tract infection hospitalized in the department of intensive care medicine of this hospital from January 2020 to July 2023 were retrospectively analyzed.According to the ICU outcomes,the patients were divided into the improvement group(n=77)and the poor prognosis group(n=25),and the receiver operating characteristic(ROC)curve was drawn to analyze the evaluation value of PSI-HR score combined with NLR,NLR,PSI-HR score,PSI-HR grade and PSI grade in the prognosis of the patients with lower respiratory tract infection.Results The case fatality rates of the patients with different grades of PSI were 40.00%(16/40)for the grade 5,18.75%(6/32)for the grade 4,22.22%(2/9)for the grade 3 and 4.76%(1/21)for the grade 2,respectively.There was no significant correlation between different PSI grades and case fatality rate(r=0.911,P=0.089).The case fatality rates of different grades of PSI-HR were 75.00%(3/4)for the grade 6,46.67%(7/15)for the grade 5,28.57%(6/21)for the grade 4,17.24%(5/29)for the grade 3,and 12.12%(4/33)for the grade 2,respectively,and the PSI-HR grade was positively correlated with the case fatality rate of the patients(r=0.955,P=0.011).The area under the ROC curve(AUC)of predicting the prognosis of the patients with lower respiratory tract infection from great to small was 0.828(95%CI:0.717-0.938,P<0.05)for PSI-HR score combined with NLR,0.754(95%CI:0.637-0.871,P<0.05)for NLR,0.744(95%CI:0.636-0.852,P<0.05)for PSI-HR score,and 0.706(95%CI:0.584-0.829,P<0.05)for PSI-HR grade and 0.695(AUC=0.695,95%CI:0.582-0.807,P<0.05)for PSI grade.Conclusion The PSI-HR grade has good correlation with the case fatality rate of the patients with lower respiratory tract infection.The efficiency of PSI-HR grade combined with NLR for predicting the prognosis in the patients with lower respiratory tract infection in ICU is better than that of single index.