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中性粒细胞/淋巴细胞值、中性粒细胞/前白蛋白值对脓毒症患者预后及器官损伤早期预警价值的研究
作者:何琪芳1  刘军1  李超1  车丹2 
单位:1. 南京医科大学附属苏州医院东区 重症医学科, 江苏 苏州 215000;
2. 南京医科大学附属苏州医院东区 统计室, 江苏 苏州 215000
关键词:脓毒症 中性粒细胞/淋巴细胞值 中性粒细胞/前白蛋白值 器官功能障碍 预后 危险因素 
分类号:R654.4
出版年·卷·期(页码):2021·40·第二期(141-147)
摘要:

目的:探讨中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞与前白蛋白比值(NPRI)对脓毒症患者院内死亡及器官功能障碍的早期预警价值。方法:回顾性分析2017年1月至2020年6月南京医科大学附属苏州医院东区重症医学科收治的175例脓毒症患者的临床资料。记录患者年龄,性别,基础疾病情况(高血压病、糖尿病、冠心病),序贯器官衰竭评分(SOFA),SOFA中各系统评分及器官功能障碍数目,入科第1天C反应蛋白(CRP)、白细胞计数、淋巴细胞计数、单核细胞计数、中性粒细胞计数、血小板计数、血清白蛋白、血清前白蛋白、血清肌酐、血清尿素氮、凝血功能,院内死亡情况;计算NLR、NPRI。依据患者是否在院内死亡将其分为生存组和死亡组,根据SOFA内各系统评分情况分为器官功能障碍阳性组、阴性组,进而分析比较NLR、NPRI在预测患者死亡及器官功能障碍中的价值。结果:死亡组患者NLR、NPRI、SOFA、器官损伤数目高于生存组(P<0.05),前白蛋白水平低于生存组(P<0.05),住院时间短于于生存组(P<0.05)。多因素二元Logstic回归分析发现NLR(OR=1.046,95%CI 1.020~1.073,P<0.001)和SOFA(OR=1.223,95%CI 1.017~1.471,P=0.032)是脓毒症患者院内死亡的独立危险因素,前白蛋白(OR=0.992,95%CI 0.985~0.999,P=0.017)是脓毒症患者院内死亡的独立保护因素。ROC曲线分析显示,NLR(AUC=0.706,95%CI 0.524~0.887,P=0.005)、NPRI(AUC=0.758,95%CI 0.621~0.895,P=0.001)、SOFA(AUC=0.715,95%CI 0.615~0.815,P=0.004)、器官损伤数目(AUC=0.655,95%CI 0.610~0.818,P=0.043)均对脓毒症患者院内死亡具有一定的预测价值。NLR在凝血异常阳性组与阴性组之间的差异有统计学意义(P=0.044),NPRI在肾脏损伤阳性组与阴性组之间的差异有统计学意义(P=0.021)。结论:NLR、SOFA是脓毒症患者院内死亡的独立危险因素,前白蛋白是脓毒症患者院内死亡的独立保护因素。NLR、SOFA、NPRI及器官损伤数目有望成为预测脓毒症患者院内死亡的指标。

Objective: To explore the early warning value of neutrophil to lymphocyte ratio (NLR) and neutrophil to prealbumin ratio (NPRI) in hospital death and organ dysfunction of septic patients. Methods: The clinical data of 175 patients with sepsis from January 2017 to June 2020 were analyzed retrospectively. The age, sex, basic diseases (hypertension, diabetes and heart disease), sequential organ failure assessment(SOFA),scores of each system in SOFA, number of organ dysfunction, C-reactive protein (CRP), white blood cell number, lymphocyte number, monocyte, neutrophil number, platelet number and albumin on the first day of admission were recorded. Patients were divided into survival group and death group according to whether they died in hospital. According to the scores of each system in SOFA, they were divided into positive group and negative group of organ dysfunction.The value of NLR and NPRI in predicting patients' death and organ dysfunction were analyzed and compared. Results: NLR, NPRI, SOFA and the number of organ injuries in the death group were higher than those in the survival group (P<0.05), while the prealbumin and hospitalization time were less than those in the survival group (P<0.05). Univariate binary Logstic regression analysis showed that NLR (OR=1.046,95%CI 1.020-1.073,P<0.001) and SOFA (OR=1.223,95%CI 1.017-1.471,P=0.032) were independent risk factors for hospital death of sepsis patients, and prealbumin (OR=0.992, 95% CI 0.985-0.998, P=0.017) was an independent protective factor for nosocomial death in patients with sepsis. Receiver operating characteristic curve analysis showed that NLR (AUC=0.706,95% CI 0.524-0.887,P=0.005), NPRI (AUC=0.7586, 95% CI 0.621-0.895, P=0.001), SOFA(AUC=0.715,95%CI 0.615-0.815,P=0.004) and the number of organ injuries (AUC=0.655, 95%CI 0.610-0.818, P=0.043) had certain predictive value for the hospital death of sepsis patients. The difference of NLR between positive and negative groups with abnormal coagulation was statistically significant (P=0.044), and the difference of NPRI between positive and negative groups with renal injury was statistically significant (P=0.021). Conclusion: NLR and SOFA are independent risk factors for nosocomial death in patients with sepsis, and prealbumin is an independent protective factor for nosocomial death in patients with sepsis. NLR, SOFA, NPRI and the number of organ injuries maybe preditive factors for the hospital death of sepsis.

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