炎症指标及血液学指标对尿路相关性血流感染的预测诊断比较及联合运用价值分析

Comparison among inflammatory markers and haematological indexes in predicting and diagnosing urinary tract-related bloodstream infections and analysis of their combined application value

目的:探讨白细胞介素6(interleukin 6,IL-6)、降钙素原(procalcitonin,PCT)、白细胞计数(white blood cell,WBC)、血小板计数(platelet,PLT)、中性粒细胞/淋巴细胞比率(neutrophils/lymphocyte ratio,NLR)、C反应蛋白(C-reactive protein,CRP)及IL-6+PCT+CRP联合检测对尿路相关性血流感染(urinary tract-related bloodstream infection,UT-BSI)的预测诊断价值。方法:回顾性分析简阳市人民医院2021年11月—2023年11月入院48 h内送检的尿培养结果阳性的252例患者临床资料,根据其血培养结果分组,尿培养阳性后7 d内血培养阳性且获得相同病原菌的患者为试验组(97例),血培养结果阴性的疑似血流感染患者(155例)为对照组,比较2组中IL-6、PCT等上述6项检测指标水平的差异。采用多因素logistic逐步回归分析UT-BSI的危险因素,采用受试者工作特征(receiver operator characteristic,ROC)曲线下面积(AUC)评估该6项检测指标及联合检测对UT-BSI的预测价值。结果:UT-BSI病原微生物以革兰阴性杆菌为主,革兰阳性球菌次之,真菌较少见。试验组IL-6、PCT等上述6项检测指标水平与对照组比较差异均有统计学意义(P<0.05)。多因素logistic逐步回归分析显示IL-6、PCT、CRP是UT-BSI的独立危险因素(P<0.05)。单项检测PCT的AUC为0.915,诊断效能最好。IL-6+PCT+CRP联合检测,其灵敏度为93.8%,特异度为87.7%,约登指数为0.815,AUC为0.953,较单项检测诊断效能更好。结论:UT-BSI病原微生物以大肠埃希菌、屎肠球菌和肺炎克雷伯菌为主;IL-6、PCT等上述6项指标均可作为尿路感染患者血流感染预测诊断的有力补充,IL-6、PCT、CRP是UT-BSI的独立危险因素,WBC、PLT、NLR诊断价值有限。单项检测指标中,PCT在UT-BSI的综合诊断效能中优于IL-6和CRP,IL-6+PCT+CRP联合检测可提高其诊断准确性,有助于临床对UT-BSI的早期诊断和病情监测。

Objective To explore the predictive diagnostic value of interleukin 6(IL-6),procalcitonin(PCT),white blood cell(WBC),platelet(PLT),neutrophil/lymphocyte ratio(NLR),C-reactive protein(CRP),and CRP+PCT+IL-6 combined detection for urinary tract-related bloodstream infection(UT-BSI).Methods From November 2021 to November 2023,252 patients with positive urine culture results within 48 hours admitted to Jianyang City People's Hospital were retrospectively analysed.According to their blood culture results,they were divided into two groups.Patients with positive blood culture within 7 days after urine culture who obtained the same microorganisms were included in the experimental group(97 cases),while 155 suspected bloodstream infection patients with negative blood culture results were selected as the control group.The levels of six detection indicators,such as IL-6,PCT and etc.were compared between the two groups.Multivariate logistic stepwise regression was used to analyze the risk factors in UT-BSI,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the six indicators and the combined detection for UT-BSI.Results The main pathogens of urinary tract associated bloodstream infection were Gram-negative bacilli,Gram-positive cocci followed,and fungi were rare.There were statistically significant differences between the experimental group and the control group in six test indexes,such as IL-6,PCT and etc(P<0.05).Multivariate logistic stepwise regression analysis showed that IL-6,PCT,and CRP were independent risk factors in UT-BSI(P<0.05).The area under curve(AUC)showed that the single detection of PCT has the highest value(0.915)and the best diagnostic performance.The combined detection of IL-6+PCT+CRP has a sensitivity of 93.8%,specificity of 87.7%,Youden index of 0.815,AUC 0.953,and better diagnostic efficacy than single detection.Conclusion The pathogenic bacteria of UT-BSI are mainly Escherichia coli,followed by Enterococcus faecalis and Klebsiella pneumoniae.These six indicators can all serve as powerful supplements for predictive diagnosis of blood flow infections in patients with urinary tract infections.IL-6,PCT,and CRP are independent risk factors in UT-BSI,while WBC,PLT,and NLR have limited diagnostic value.Among six detection indicators,PCT is superior to IL-6 and CRP in the comprehensive diagnostic performance of UT-BSI.The combined detection of IL-6+PCT+CRP can improve its diagnostic accuracy,which is helpful for the early diagnosis and monitoring of UT-BSI in clinical practice.