Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identif...Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.展开更多
BACKGROUND Colorectal cancer is the third most common malignancy worldwide.Therefore,it is critically important to identify new useful markers that can be easily obtained in routine practice.Inflammation is a crucial ...BACKGROUND Colorectal cancer is the third most common malignancy worldwide.Therefore,it is critically important to identify new useful markers that can be easily obtained in routine practice.Inflammation is a crucial issue in the pathogenesis and development of cancer.AIM To evaluate the prognostic value of absolute monocyte count,monocyte to lymphocyte ratio(MLR),the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio(NLR-PLR),and combined platelet and neutrophilto-lymphocyte ratio(PLT-NLR)in peripheral blood samples of patients with colorectal cancer undergoing surgery.METHODS We conducted a retrospective study of 160 patients with colorectal cancer who underwent surgery,and 42 healthy controls.The status of absolute monocyte count,MLR,NLR-PLR and PLT-NLR was calculated on the basis of blood samples obtained before and after surgery.Haematologic factors were examined in correlation with the type of tumour growth,tumour size,histological type,percentage of mucinous component,grade of malignancy,Tumour-Node-Metastasis stage,venous,lymphatic and perineural invasion of cancer cells,status of lymph node invasion and the presence of cancer cell deposits.The Kaplan-Meier method and the long-rank test were used to compare survival curves.To determine independent prognostic factors,univariate and multivariate Cox proportional hazards regression models were applied.RESULTS The PLT-NLR status was correlated with tumour size and the presence of perineural invasion(P=0.015;P=-0.174,P=0.037).Moreover,high NLR-PLR and PLR-NLR ratios in the blood samples obtained after surgery were positively associated with histological type of cancer and percentage of the mucinous component(NLR-PLR:P=0.002;P=0.009;PLR-NLR status:P=0.002;P=0.007).The analysis of 5-year disease-free survival showed that the MLR of whole blood obtained after surgery[HR=2.903,95%CI:(1.368-6.158),P=0.005]and the status of lymph node metastasis[HR=0.813,95%CI:(0.653-1.013),P=0.050]were independent prognostic factors in colorectal cancer patients.CONCLUSION The postoperative MLR in whole blood samples can be used as an independent prognostic factor in patients diagnosed with colorectal cancer.展开更多
Background and objective: During routine follow up, there is no specific predictor to ascertain relapse after standard first line chemotherapy in diffuse large cell lymphoma. Therefore, this study was designed to asse...Background and objective: During routine follow up, there is no specific predictor to ascertain relapse after standard first line chemotherapy in diffuse large cell lymphoma. Therefore, this study was designed to assess the prognostic significance of the ratio between absolute lymphocyte and monocyte counts (LMR) in the peripheral blood to verify relapse in diffuse large B cell lymphoma. Patients and methods: A total of 139 patients with newly diagnosed diffuse large B cell lymphoma (DLBCL) were evaluated and treated with CHOP or R-CHOP between the years 2009 and 2016. Three months following completion of first line therapy, Lymphocyte/monocyte ratio (LMR) was calculated from the routine automated complete blood cell count (CBC) attained a plateau after the bone marrow recovery after first line chemotherapy. The absolute lymphocyte count/absolute monocyte count ratio (LMR) was calculated by dividing the ALC by the AMC. Results: ROC curve analysis of 139 patients established 2.8 as cutoff point of LMR for relapse with AUC of 0.97 (95% CI 0.93 - 0.99, P ≤ 0.001). Cox regression analysis was performed to identify factors predicting relapse. In univariate regression analysis, ALC (95% CI 0.003 - 0.03, p ≤ 0.001), AMC (95% CI 15.4 - 128.8, p ≤ 0.001), LMR (95% CI 0.001 - 0.01, p ≤ 0.001), and LDH (95% CI 0.1 - 0.5, p ≤ 0.001) following completion of therapy are significant factors for relapse. Other significant factors for relapse are Ann Arbor stage (95% CI 1.1 - 6.9, P = 0.03), extranodal sites (95% CI 1.2 - 6.1, P = 0.01), age (95% CI 1.3 - 6.5, P = 0.01) and treatment of CHOP protocol (95% CI 0.05 - 0.6, P = 0.007). In a multivariate analysis LMR following completion of therapy was predictive for relapse (95% CI 0.001 - 0.2, P = 0.005). ALC was also significant in multivariate analysis (95% CI 0.01 - 0.8, P = 0.03). LDH following completion of therapy (95% CI 0.2 - 14.9, P = 0.5), AMC following completion of therapy (95% CI 0.3 - 43.1, P = 0.3), age (95% CI 0.9 - 205.4, P = 0.06), extra-nodal sites (95% CI 0.04 - 9.8, P = 0.8), Ann Arbor stage (95% CI 0.3 - 28.7, P = 0.3), and Treatment of CHOP protocol (95% CI 0.01 - 2.4, P = 0.2) were not statistically significant. Conclusion: This study observed that LMR assessed after first line chemotherapy during routine follow up is an independent predictor of relapse and clinical outcome in DLBCL patients. LMR at follow up can be used a simple inexpensive biomarker to alert clinicians for relapse during follow up after standard first line chemotherapy in DLBCL patients.展开更多
Background With the continuous exploration of cardiovascular diseases,research has found that inflammatory reactions play an important role in the pathogenesis of cardiovascular diseases.In recent years,the ratio of m...Background With the continuous exploration of cardiovascular diseases,research has found that inflammatory reactions play an important role in the pathogenesis of cardiovascular diseases.In recent years,the ratio of monocyte to lymphocyte counts(MLR)has attracted widespread attention as a novel inflammatory marker.Therefore,this article will focus on the value of MLR in terms of prevalence risk,severity and prognosis in common cardiovascular diseases.[S Chin J Cardiol 2024;25(3):200-206]展开更多
AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection...AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio(NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ~2 tests where appropriate.RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9(P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio(≥ 0.25, P = 0.044). CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.展开更多
目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房...目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房(emergency intensive care unit,EICU)2018年1月~2023年1月收治的310例重症肺炎合并脓毒症患儿的临床资料,对所有患儿治疗出院后进行门诊复查或电话随访并根据相关标准对患儿预后进行评估,根据预后情况分为预后良好组(n=198)和预后不良组(n=112)。利用医院电子病历系统,收集全部患儿年龄、性别等基本临床资料,记录入院时患儿早期预警评分[慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)],并收集诊断患儿入院24 h内的实验室指标。采用Logistic回归分析肺炎合并脓毒症患儿发生预后不良的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLT计数、D-D预测重症肺炎合并脓毒症患儿预后的灵敏度、特异度、准确度。结果两组患儿年龄、性别差异无统计学意义(P>0.05)。预后不良组APACHEⅡ、SOFA评分显著高于预后良好组(P<0.05)。预后良好组NLR、D-D水平均低于预后不良组,PLT计数水平高于预后不良组(P<0.05)。将单因素分析的结果中P≤0.05的变量纳入多因素Logistic回归确定影响预后的独立危险因素。调整年龄、性别、APACHEⅡ评分等混杂因素,连续变量原值收入,结果表明,NLR、D-D水平是预后的保护因素(OR<1,P<0.05),PLT计数水平是预后的危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,三项指标联合预测的曲线下面积(area under the curve,AUC)为0.949,灵敏度为94.95%,特异度为82.14%,准确度为90.32%,三者联合预测效能价值高。结论重症肺炎合并脓毒症患儿的外周血NLR、PLT计数、D-D水平显著升高,三项联合检测在预测患儿28 d后的预后中具有重要的价值。展开更多
目的探讨乳酸/白蛋白比值(LAR)、白细胞介素-6(IL-6)、CD4^(+)T淋巴细胞计数对重症肺炎并脓毒症患者28 d死亡的预测价值。方法选择2022年1月至2023年6月郑州大学附属郑州中心医院呼吸重症医学科(RICU)收治的73例重症肺炎并脓毒症患者为...目的探讨乳酸/白蛋白比值(LAR)、白细胞介素-6(IL-6)、CD4^(+)T淋巴细胞计数对重症肺炎并脓毒症患者28 d死亡的预测价值。方法选择2022年1月至2023年6月郑州大学附属郑州中心医院呼吸重症医学科(RICU)收治的73例重症肺炎并脓毒症患者为研究对象,依据患者28 d生存结局将其分为生存组(n=43)和死亡组(n=30)。通过查阅电子病历收集患者的临床资料,包括:年龄、性别及合并高血压、糖尿病、冠状动脉性心脏病(CHD)情况,入住RICU治疗时的序贯器官衰竭评分(SOFA)、急性生理与慢性健康状态评价系统Ⅱ(APACHEⅡ)评分、平均动脉压(MAP)、英国胸科协会改良肺炎评分(CURB-65)、总胆红素(Tbil)、血肌酐(Scr)、血小板计数(PLT)、白细胞(WBC)计数、降钙素原(PCT)、C-反应蛋白(CRP)。入住RICU后第1、3、7天,抽取患者动脉血,应用全自动血气分析仪检测乳酸水平;抽取患者外周静脉血,应用酶联免疫吸附试验检测患者血清中白蛋白和白细胞介素-6(IL-6)水平,流式细胞仪检测CD4^(+)T淋巴细胞亚群计数;计算2组患者第1、3、7天的LAR。比较2组患者的临床资料及第1、3、7天的LAR、IL-6及CD4^(+)T淋巴细胞计数水平,应用logistic回归分析重症肺炎并脓毒症患者28 d死亡的影响因素,受试者操作特征(ROC)曲线评估各影响因素对重症肺炎并脓毒症患者28 d死亡的预测价值。结果2组患者的性别、年龄、合并高血压占比、合并糖尿病占比、合并CHD占比、RICU住院时间以及入住RICU时的Tbil、MAP、PLT、Scr、WBC、PCT、CRP比较差异均无统计学意义(P>0.05);死亡组患者的APACHEⅡ评分、CURB-65评分显著高于生存组(P<0.05)。第1、3、7天,死亡组患者的CD4^(+)T淋巴细胞计数显著低于生存组,SOFA评分显著高于生存组(P<0.05)。第1天,死亡组与生存组患者的LAR、IL-6水平比较差异无统计学意义(P>0.05);第3、7天,死亡组患者的LAR及IL-6水平显著高于生存组(P<0.05)。生存组患者第3、7天的LAR、IL-6、SOFA评分显著低于第1天,第7天的LAR、IL-6、SOFA显著低于第3天(P<0.05);生存组患者第3、7天的CD4^(+)T淋巴细胞计数显著高于第1天(P<0.05);生存组患者第7天与第3天的CD4^(+)T淋巴细胞计数比较差异无统计学意义(P>0.05)。死亡组患者第7天的IL-6水平显著低于第1、3天(P<0.05),第1天的IL-6水平与第3天比较差异无统计学意义(P>0.05);LAR、CD4^(+)T淋巴细胞计数、SOFA评分各时间点间比较差异无统计学意义(P>0.05)。Pearson相关性分析显示,第3天,重症肺炎并脓毒症患者LAR、IL-6水平与SOFA评分呈显著正相关(r=0.385、0.394,P<0.05);第7天,LAR、IL-6与SOFA评分亦呈显著正相关(r=0.418、0.402,P<0.05);第3、7天,CD4^(+)T淋巴细胞计数与SOFA评分均呈显著负相关(r=-0.451、-0.454,P<0.05)。Logistic回归分析结果显示,APACHEⅡ评分、第3天的LAR、IL-6、CD4^(+)T淋巴细胞计数及第7天的IL-6、CD4^(+)T淋巴细胞计数是重症肺炎并脓毒症28 d死亡的影响因素(P<0.05)。ROC曲线显示,APACHEⅡ评分,第3天的LAR、IL-6、CD4^(+)T淋巴细胞计数及三者联合,第7天的IL-6、CD4^(+)T淋巴细胞计数及二者联合对重症肺炎并脓毒症患者的28 d死亡均有一定预测价值(P<0.05);第3天的LAR、IL-6和CD4^(+)T淋巴细胞计数联合预测重症肺炎并脓毒症患者28 d死亡的ROC曲线下面积(AUC)为0.891,APACHEⅡ评分预测重症肺炎并脓毒症患者28 d死亡的AUC值为0.769,第3天的LAR、IL-6、CD4^(+)T淋巴细胞计数预测重症肺炎并脓毒症28 d死亡的AUC值分别为0.795、0.757、0.770,第7天的IL-6、CD4^(+)T淋巴细胞计数及二者联合预测重症肺炎并脓毒症28 d死亡的AUC值分别为0.743、0.802、0.888。结论入院3 d LAR、3 d IL-6、3 d CD4^(+)T淋巴细胞计数以及7 d IL-6、7 d CD4^(+)T淋巴细胞计数是影响重症肺炎并脓毒症患者28 d死亡的相关因素;联合检测第3天的LAR、IL-6、CD4^(+)T淋巴细胞计数能够更好地评估患者病情严重程度及预后。展开更多
文摘Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.
文摘BACKGROUND Colorectal cancer is the third most common malignancy worldwide.Therefore,it is critically important to identify new useful markers that can be easily obtained in routine practice.Inflammation is a crucial issue in the pathogenesis and development of cancer.AIM To evaluate the prognostic value of absolute monocyte count,monocyte to lymphocyte ratio(MLR),the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio(NLR-PLR),and combined platelet and neutrophilto-lymphocyte ratio(PLT-NLR)in peripheral blood samples of patients with colorectal cancer undergoing surgery.METHODS We conducted a retrospective study of 160 patients with colorectal cancer who underwent surgery,and 42 healthy controls.The status of absolute monocyte count,MLR,NLR-PLR and PLT-NLR was calculated on the basis of blood samples obtained before and after surgery.Haematologic factors were examined in correlation with the type of tumour growth,tumour size,histological type,percentage of mucinous component,grade of malignancy,Tumour-Node-Metastasis stage,venous,lymphatic and perineural invasion of cancer cells,status of lymph node invasion and the presence of cancer cell deposits.The Kaplan-Meier method and the long-rank test were used to compare survival curves.To determine independent prognostic factors,univariate and multivariate Cox proportional hazards regression models were applied.RESULTS The PLT-NLR status was correlated with tumour size and the presence of perineural invasion(P=0.015;P=-0.174,P=0.037).Moreover,high NLR-PLR and PLR-NLR ratios in the blood samples obtained after surgery were positively associated with histological type of cancer and percentage of the mucinous component(NLR-PLR:P=0.002;P=0.009;PLR-NLR status:P=0.002;P=0.007).The analysis of 5-year disease-free survival showed that the MLR of whole blood obtained after surgery[HR=2.903,95%CI:(1.368-6.158),P=0.005]and the status of lymph node metastasis[HR=0.813,95%CI:(0.653-1.013),P=0.050]were independent prognostic factors in colorectal cancer patients.CONCLUSION The postoperative MLR in whole blood samples can be used as an independent prognostic factor in patients diagnosed with colorectal cancer.
文摘Background and objective: During routine follow up, there is no specific predictor to ascertain relapse after standard first line chemotherapy in diffuse large cell lymphoma. Therefore, this study was designed to assess the prognostic significance of the ratio between absolute lymphocyte and monocyte counts (LMR) in the peripheral blood to verify relapse in diffuse large B cell lymphoma. Patients and methods: A total of 139 patients with newly diagnosed diffuse large B cell lymphoma (DLBCL) were evaluated and treated with CHOP or R-CHOP between the years 2009 and 2016. Three months following completion of first line therapy, Lymphocyte/monocyte ratio (LMR) was calculated from the routine automated complete blood cell count (CBC) attained a plateau after the bone marrow recovery after first line chemotherapy. The absolute lymphocyte count/absolute monocyte count ratio (LMR) was calculated by dividing the ALC by the AMC. Results: ROC curve analysis of 139 patients established 2.8 as cutoff point of LMR for relapse with AUC of 0.97 (95% CI 0.93 - 0.99, P ≤ 0.001). Cox regression analysis was performed to identify factors predicting relapse. In univariate regression analysis, ALC (95% CI 0.003 - 0.03, p ≤ 0.001), AMC (95% CI 15.4 - 128.8, p ≤ 0.001), LMR (95% CI 0.001 - 0.01, p ≤ 0.001), and LDH (95% CI 0.1 - 0.5, p ≤ 0.001) following completion of therapy are significant factors for relapse. Other significant factors for relapse are Ann Arbor stage (95% CI 1.1 - 6.9, P = 0.03), extranodal sites (95% CI 1.2 - 6.1, P = 0.01), age (95% CI 1.3 - 6.5, P = 0.01) and treatment of CHOP protocol (95% CI 0.05 - 0.6, P = 0.007). In a multivariate analysis LMR following completion of therapy was predictive for relapse (95% CI 0.001 - 0.2, P = 0.005). ALC was also significant in multivariate analysis (95% CI 0.01 - 0.8, P = 0.03). LDH following completion of therapy (95% CI 0.2 - 14.9, P = 0.5), AMC following completion of therapy (95% CI 0.3 - 43.1, P = 0.3), age (95% CI 0.9 - 205.4, P = 0.06), extra-nodal sites (95% CI 0.04 - 9.8, P = 0.8), Ann Arbor stage (95% CI 0.3 - 28.7, P = 0.3), and Treatment of CHOP protocol (95% CI 0.01 - 2.4, P = 0.2) were not statistically significant. Conclusion: This study observed that LMR assessed after first line chemotherapy during routine follow up is an independent predictor of relapse and clinical outcome in DLBCL patients. LMR at follow up can be used a simple inexpensive biomarker to alert clinicians for relapse during follow up after standard first line chemotherapy in DLBCL patients.
文摘Background With the continuous exploration of cardiovascular diseases,research has found that inflammatory reactions play an important role in the pathogenesis of cardiovascular diseases.In recent years,the ratio of monocyte to lymphocyte counts(MLR)has attracted widespread attention as a novel inflammatory marker.Therefore,this article will focus on the value of MLR in terms of prevalence risk,severity and prognosis in common cardiovascular diseases.[S Chin J Cardiol 2024;25(3):200-206]
文摘AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio(NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ~2 tests where appropriate.RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9(P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio(≥ 0.25, P = 0.044). CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.
文摘目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房(emergency intensive care unit,EICU)2018年1月~2023年1月收治的310例重症肺炎合并脓毒症患儿的临床资料,对所有患儿治疗出院后进行门诊复查或电话随访并根据相关标准对患儿预后进行评估,根据预后情况分为预后良好组(n=198)和预后不良组(n=112)。利用医院电子病历系统,收集全部患儿年龄、性别等基本临床资料,记录入院时患儿早期预警评分[慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)],并收集诊断患儿入院24 h内的实验室指标。采用Logistic回归分析肺炎合并脓毒症患儿发生预后不良的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLT计数、D-D预测重症肺炎合并脓毒症患儿预后的灵敏度、特异度、准确度。结果两组患儿年龄、性别差异无统计学意义(P>0.05)。预后不良组APACHEⅡ、SOFA评分显著高于预后良好组(P<0.05)。预后良好组NLR、D-D水平均低于预后不良组,PLT计数水平高于预后不良组(P<0.05)。将单因素分析的结果中P≤0.05的变量纳入多因素Logistic回归确定影响预后的独立危险因素。调整年龄、性别、APACHEⅡ评分等混杂因素,连续变量原值收入,结果表明,NLR、D-D水平是预后的保护因素(OR<1,P<0.05),PLT计数水平是预后的危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,三项指标联合预测的曲线下面积(area under the curve,AUC)为0.949,灵敏度为94.95%,特异度为82.14%,准确度为90.32%,三者联合预测效能价值高。结论重症肺炎合并脓毒症患儿的外周血NLR、PLT计数、D-D水平显著升高,三项联合检测在预测患儿28 d后的预后中具有重要的价值。
文摘目的探讨乳酸/白蛋白比值(LAR)、白细胞介素-6(IL-6)、CD4^(+)T淋巴细胞计数对重症肺炎并脓毒症患者28 d死亡的预测价值。方法选择2022年1月至2023年6月郑州大学附属郑州中心医院呼吸重症医学科(RICU)收治的73例重症肺炎并脓毒症患者为研究对象,依据患者28 d生存结局将其分为生存组(n=43)和死亡组(n=30)。通过查阅电子病历收集患者的临床资料,包括:年龄、性别及合并高血压、糖尿病、冠状动脉性心脏病(CHD)情况,入住RICU治疗时的序贯器官衰竭评分(SOFA)、急性生理与慢性健康状态评价系统Ⅱ(APACHEⅡ)评分、平均动脉压(MAP)、英国胸科协会改良肺炎评分(CURB-65)、总胆红素(Tbil)、血肌酐(Scr)、血小板计数(PLT)、白细胞(WBC)计数、降钙素原(PCT)、C-反应蛋白(CRP)。入住RICU后第1、3、7天,抽取患者动脉血,应用全自动血气分析仪检测乳酸水平;抽取患者外周静脉血,应用酶联免疫吸附试验检测患者血清中白蛋白和白细胞介素-6(IL-6)水平,流式细胞仪检测CD4^(+)T淋巴细胞亚群计数;计算2组患者第1、3、7天的LAR。比较2组患者的临床资料及第1、3、7天的LAR、IL-6及CD4^(+)T淋巴细胞计数水平,应用logistic回归分析重症肺炎并脓毒症患者28 d死亡的影响因素,受试者操作特征(ROC)曲线评估各影响因素对重症肺炎并脓毒症患者28 d死亡的预测价值。结果2组患者的性别、年龄、合并高血压占比、合并糖尿病占比、合并CHD占比、RICU住院时间以及入住RICU时的Tbil、MAP、PLT、Scr、WBC、PCT、CRP比较差异均无统计学意义(P>0.05);死亡组患者的APACHEⅡ评分、CURB-65评分显著高于生存组(P<0.05)。第1、3、7天,死亡组患者的CD4^(+)T淋巴细胞计数显著低于生存组,SOFA评分显著高于生存组(P<0.05)。第1天,死亡组与生存组患者的LAR、IL-6水平比较差异无统计学意义(P>0.05);第3、7天,死亡组患者的LAR及IL-6水平显著高于生存组(P<0.05)。生存组患者第3、7天的LAR、IL-6、SOFA评分显著低于第1天,第7天的LAR、IL-6、SOFA显著低于第3天(P<0.05);生存组患者第3、7天的CD4^(+)T淋巴细胞计数显著高于第1天(P<0.05);生存组患者第7天与第3天的CD4^(+)T淋巴细胞计数比较差异无统计学意义(P>0.05)。死亡组患者第7天的IL-6水平显著低于第1、3天(P<0.05),第1天的IL-6水平与第3天比较差异无统计学意义(P>0.05);LAR、CD4^(+)T淋巴细胞计数、SOFA评分各时间点间比较差异无统计学意义(P>0.05)。Pearson相关性分析显示,第3天,重症肺炎并脓毒症患者LAR、IL-6水平与SOFA评分呈显著正相关(r=0.385、0.394,P<0.05);第7天,LAR、IL-6与SOFA评分亦呈显著正相关(r=0.418、0.402,P<0.05);第3、7天,CD4^(+)T淋巴细胞计数与SOFA评分均呈显著负相关(r=-0.451、-0.454,P<0.05)。Logistic回归分析结果显示,APACHEⅡ评分、第3天的LAR、IL-6、CD4^(+)T淋巴细胞计数及第7天的IL-6、CD4^(+)T淋巴细胞计数是重症肺炎并脓毒症28 d死亡的影响因素(P<0.05)。ROC曲线显示,APACHEⅡ评分,第3天的LAR、IL-6、CD4^(+)T淋巴细胞计数及三者联合,第7天的IL-6、CD4^(+)T淋巴细胞计数及二者联合对重症肺炎并脓毒症患者的28 d死亡均有一定预测价值(P<0.05);第3天的LAR、IL-6和CD4^(+)T淋巴细胞计数联合预测重症肺炎并脓毒症患者28 d死亡的ROC曲线下面积(AUC)为0.891,APACHEⅡ评分预测重症肺炎并脓毒症患者28 d死亡的AUC值为0.769,第3天的LAR、IL-6、CD4^(+)T淋巴细胞计数预测重症肺炎并脓毒症28 d死亡的AUC值分别为0.795、0.757、0.770,第7天的IL-6、CD4^(+)T淋巴细胞计数及二者联合预测重症肺炎并脓毒症28 d死亡的AUC值分别为0.743、0.802、0.888。结论入院3 d LAR、3 d IL-6、3 d CD4^(+)T淋巴细胞计数以及7 d IL-6、7 d CD4^(+)T淋巴细胞计数是影响重症肺炎并脓毒症患者28 d死亡的相关因素;联合检测第3天的LAR、IL-6、CD4^(+)T淋巴细胞计数能够更好地评估患者病情严重程度及预后。
