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-东南大学学报医学版

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

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.

参考文献：

[1] SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[2] PRESCOTT H C,ANGUS D C.Enhancing recovery from sepsis:A review[J].JAMA,2018,319(1):62-75.
[3] 谭伟,田辉,袁强,等.外周血NLR和CRP/ALB值对获得性败血症预后评估的临床价值[J].现代医学,2020,48(6):699-704.
[4] BU X,ZHANG L,CHEN P,et al.Relation of neutrophil-to-lymphocyte ratio to acute kidney injury in patients with sepsis and septic shock:A retrospective study[J].Int Immunopharmacol,2019,70:372-377.
[5] LIAN J,JIN C,HAO S,et al.High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19:a multicenter retrospective study[J].Aging(Albany NY),2020,12(14):13849-13859.
[6] ZHU S,DONG L,CAI W.Predictive value of neutrophil to lymphocyte and platelet to lymphocyte ratio in COVID-19[J].Crit Care,2020,24(1):532.
[7] 陈铀,王开杰,罗豫川,等.中性粒细胞/淋巴细胞比值对新型冠状病毒肺炎重型患者心肌损伤的预测价值[J].中华心血管病杂志,2020,48(7):572-579.
[8] HUANG X T,HUANG C S,LI J H,et al.Prognostic significance of neutrophil/prealbumin ratio for intrahepatic cholangiocarcinoma undergoing curative resection[J].HPB(Oxford),2018,20(12):1215-1222.
[9] RUBIO I,OSUCHOWSKI M F,SHANKAR-HARI M,et al.Current gaps in sepsis immunology:new opportunities for translational research[J].Lancet Infect Dis,2019,19(12):e422-e436.
[10] 刘军.全身性感染免疫功能监测研究进展[J].中华医学杂志,2017,97(21):1677-1680.
[11] 刘军.对全身性感染免疫与炎症关系的思考[J].中华急诊医学杂志,2017,26(11):1230-1235.
[12] 刘军.持续炎症-免疫抑制-分解代谢综合征的共识与争议[J].中华医学杂志,2019,99(13):961-964.
[13] VENET F,MONNERET G.Advances in the understanding and treatment of sepsis-induced immunosuppression[J].Nat Rev Nephrol,2018,14(2):121-137.
[14] LORENTE D,MATEO J,TEMPLETON A J,et al.Baseline neutrophil-lymphocyte ratio (NLR) is associated with survival and response to treatment with second-line chemotherapy for advanced prostate cancer independent of baseline steroid use[J].Ann Oncol,2015,26(4):750-755.
[15] DELL'AQUILA E,CREMOLINI C,ZEPPOLA T,et al.Prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer:a retrospective analysis of the TRIBE study by GONO[J].Ann Oncol,2018,29(4):924-930.
[16] 周高亮,乔勇,冯俊.中性粒细胞与淋巴细胞比值对急性ST段抬高型心肌梗死患者PCI术后发生造影剂肾病的预测价值[J].东南大学学报(医学版),2020,39(4):413-419.
[17] 潘慧明,查丽芬,李倩,等.中性粒细胞淋巴细胞比值和血小板淋巴细胞比值对AECOPD患者住院死亡率的预后影响[J].临床肺科杂志,2019(11):1974-1978.
[18] DILEKTASLI E,INABA K,HALTMEIER T,et al.The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients[J].J Trauma Acute Care Surg,2016,81(5):882-888.
[19] DJORDJEVIC D,RONDOVIC G,SURBATOVIC M,et al.Neutrophil-to-lymphocyte ratio,monocyte-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients:which ratio to choose to predict outcome and nature of bacteremia?[J].Mediators Inflamm,2018,2018:3758068.
[20] KAUSHIK R,GUPTA M,SHARMA M,et al.Diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in early and late phase of sepsis[J].Indian J Crit Care Med,2018,22(9):660-663.
[21] 陈鸿健,周凯,梅小丽.儿童严重脓毒症危险因素分析[J].东南大学学报(医学版),2018,37(5):854-857.
[22] DE STOPPELAAR S F,VAN'T VEER C,VAN DER POLL T.The role of platelets in sepsis[J].Thromb Haemost,2014,112(4):666-677.
[23] RAITH E P,UDY A A,BAILEY M,et al.Prognostic accuracy of the SOFA score,SIRS criteria,and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit[J].JAMA,2017,317(3):290-300.
[24] DE GROOTH H J,GEENEN I L,GIRBES A R,et al.SOFA and mortality endpoints in randomized controlled trials:a systematic review and meta-regression analysis[J].Crit Care,2017,21(1):38.
[25] 吴惠兰,毛春芬,陈晓君.联合检测血清降钙素原、血清前白蛋白和视黄醇结合蛋白对脓毒血症早期诊断的价值[J].中国医师进修杂,2019,42(12):1093-1096.
[26] 王晓玲.前白蛋白在临床的应用价值[J].临床军医杂志,2010,38(4):586,891.
[27] 陈怡发.降钙素原、C反应蛋白及前白蛋白在评估创伤性休克病情中的价值[J].实用临床医药杂志,2014,18(11):180-181.
[28] DEVAKONDA A,GEORGE L,RAOOF S,et al.Transthyretin as a marker to predict outcome in critically ill patients[J].Clin Biochem,2008,41(14-15):1126-1130.
[29] CHENG V,INABA K,HALTMEIER T,et al.Serum transthyretin is a predictor of clinical outcomes in critically ill trauma patients[J].Surgery,2015,158(2):438-444.
[30] HALTMEIER T,INABA K,DURSO J,et al.Transthyretin at admission and over time as a marker for clinical outcomes in critically ill trauma patients:A prospective single-center study[J].World J Surg,2020,44(1):115-123.
[31] 陈文秀,沈骁,宋晓春,等.联合检测中性粒细胞与白蛋白比值和乳酸对脓毒性休克患者早期预后的评估价值[J/OL].中华危重症医学杂志(电子版),2020,13(2):100-105.

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