外周血血小板/淋巴细胞比值对泌尿系统术后感染的预测效能分析

Predictive efficacy of the peripheral blood platelet-to-lymphocyte ratio(PLR)for postoperative infection in the urinary system

目的探讨外周血血小板/淋巴细胞比值(PLR)对泌尿系统术后感染的预测效能,以期为临床决策的制定提供参考。方法选取2020年10月—2023年10月于西京医院九八六医院进行泌尿系统手术治疗的122例患者作为研究对象,根据术后是否发生感染分为感染组(n=48)和未感染组(n=74)。所有患者入院后于术前采用全自动血液分析仪检测外周血血小板、淋巴细胞水平,并计算PLR。采用受试者工作特征(ROC)曲线分析PLR对患者泌尿系统术后感染的预测价值;采用多因素logistic回归分析探讨患者泌尿系统术后感染的影响因素。结果感染组患者外周血血小板、PLR均高于未感染组,淋巴细胞低于未感染组(P<0.05);血小板、淋巴细胞预测患者泌尿系统术后感染的曲线下面积(AUC)分别为0.709(95%CI:0.664~0.759)、0.826(95%CI:0.781~0.876),PLR预测患者泌尿系统术后感染的AUC为0.932(95%CI:0.887~0.982)。未感染组和感染组患者的性别、年龄、身体质量指数、疾病类型、24 h尿量、预防性使用抗菌药物人数比例、术后收缩压、术后舒张压比较,差异均无统计学意义(P>0.05);未感染组和感染组患者术后留置尿管时间、有创诊治措施次数、手术方式、白细胞计数、C反应蛋白(CRP)、手术时间、住院时间比较,差异均有统计学意义(P<0.05)。多因素logistic逐步回归分析结果显示:术后留置尿管时间(OR=2.421,95%CI:1.412~4.150)、手术方式(OR=1.808,95%CI:1.191~2.744)、手术时间(OR=1.891,95%CI:1.233~2.899)、住院时间(OR=2.751,95%CI:1.513~5.002)、白细胞计数(OR=2.140,95%CI:1.316~3.480)、CRP(OR=2.502,95%CI:1.491~4.197)、PLR(OR=3.168,95%CI:1.808~5.549)是患者泌尿系统术后感染的影响因素(P<0.05)。结论术前高PLR是患者泌尿系统术后感染的危险因素之一,并有望作为预测泌尿系统术后感染的重要指标。

Objective To explore the predictive efficacy of the peripheral blood platelet-to-lymphocyte ratio(PLR)for postoperative infection in patients receiving surgery in the urinary system,aiming to provide a reference for clinical decision-making.Methods A total of 122 patients who underwent urinary system surgery at the Xijing 986 Hospital from October 2020 to October 2023 were selected as the study participants and divided into an infection group(n=48)and a non-infection group(n=74)based on whether postoperative infection occurred.All patients underwent peripheral blood platelet and lymphocyte testing with a fully automated blood analyzer on the day before surgery,and the PLR was calculated.The receiver operating characteristic(ROC)curve analysis was used to assess the predictive value of PLR for postoperative infection in patients receiving urinary system surgery.Multifactorial logistic regression analysis was employed to explore the influencing factors of postoperative infection in patients.Results Patients in the infection group had significantly higher peripheral blood platelet counts and PLR than those in the non-infection group,and significantly lower lymphocyte counts than those in the non-infection group(P<0.05).The area under the ROC curve(AUC)for platelets and lymphocytes in predicting postoperative infection in patients was 0.709(95%CI:0.664-0.759)and 0.826(95%CI:0.781-0.876),respectively.Moreover,the AUC for PLR in predicting postoperative infection in patients was 0.932(95%CI:0.887-0.982).No statistically significant differences were noted in gender,age,body mass index,disease type,24-hour urine volume,proportion of patients receiving prophylactic antibiotics,postoperative systolic blood pressure,and postoperative diastolic blood pressure between the non-infected and infected groups(P>0.05);however,statistically significant differences were found in the duration of indwelling catheter postoperatively,the number of invasive diagnostic and therapeutic procedures,surgical methods,white blood cell count,C-reactive protein(CRP),time of operation,and hospital stay between the two groups(P<0.05).Multivariate logistic stepwise regression analysis showed that the duration of the indwelling catheter postoperatively(OR=2.421,95%CI:1.412-4.150),surgical method(OR=1.808,95%CI:1.191-2.744),time of operation(OR=1.891,95%CI:1.233-2.899),length of hospital stay(OR=2.751,95%CI:1.513-5.002),white blood cell count(OR=2.140,95%CI:1.316-3.480),CRP(OR=2.502,95%CI:1.491-4.197),and PLR(OR=3.168,95%CI:1.808-5.549)were influencing factors for postoperative infection in patients(P<0.05).Conclusion A high preoperative PLR remains one of the risk factors for postoperative infection in patients receiving surgery in the urinary system and has the potential to be an important indicator for predicting postoperative infection in the urinary system.