Predictive value of neutrophil-to-lymphocyte radio in 28-day mortality of patients with sepsis shock
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摘要: 目的: 探讨中性粒细胞与淋巴细胞比值(NLR)对脓毒性休克患者28d死亡风险的预测价值。方法: 回顾性分析2017-01—2018-12期间收住我院急诊科的121例脓毒性休克患者的临床资料,以28d预后情况分为存活组(73例)和死亡组(48例)。单因素和多因素Logistic回归分析临床资料确定脓毒性休克患者死亡的高危因素。利用受试者工作特征曲线(receiver operator curve,ROC)评估NLR对脓毒性休克患者28d死亡风险的预测价值。Pearson相关性分析探讨NLR与脓毒性休克患者急性生理与慢性健康Ⅱ(APACHEⅡ)评分之间的相关性。结果: 脓毒性休克患者总体病死率为39.66%(48/121)。多因素Logistic回归分析显示,NLR、Lac、PCT、APACHE II评分是脓毒性休克患者死亡的危险因素。NLR预测效能的ROC曲线下面积分别为0.784(95%CI:0.698~0.871,P<0.05),最佳截断值为20.01(敏感度66.67%、特异度83.56%;阳性预测值80.22%,阴性预测值71.49%,阳性似然比4.06,阴性似然比0.40)。NLR与APACHEⅡ评分呈中等强度相关(r=0.401,P<0.01)。APACHE II评分≥20的患者NLR值明显高于APACHE II评分<20组(19.41±6.93vs.14.53±5.58,P<0.05)。结论: NLR增高是脓毒性休克患者死亡的高危因素,其与APACHEⅡ评分具有良好的相关性,对脓毒性性休克患者的28d死亡风险具有良好的预测价值。
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关键词:
- 脓毒性休克 /
- 中性粒细胞与淋巴细胞比值 /
- 预测价值 /
- 病死率
Abstract: Objective: To investigate the predictive value of neutrophil-to-lymphocyte radio(NLR)in 28-day mortality of patients with sepsis shock.Method: We respectively reviewed the clinical parameters of 121 patients with sepsis shock admitted to Emergency Department of the First Affiliated Hospital of Xi'an Jiaotong University from January 2017 to December 2018.They were divided into survival(n=73)and non-survival(n=48)groups based on their 28-day prognosis.Multivariate logistic regression was performed to identify risk factors of 28-day mortality.Receiver operating curve(ROC)test was applied to analysis the predictive value of NLR in 28-day mortality of sepsis shock patients.The correlations between NLR and Acute Physiology and Chronic Health EvaluationⅡscore(APACHE Ⅱ)were analyzed using Pearson correlation analysis.Result: The total mortality in 28-day was 39.66%(48/121).Multivariate logistic regression analysis showed that NLR,Lac,PCT,APACHE II score were risk factors for predicting death in patients with sepsis shock.The area under the ROC curve of the NLR for predicting the death was 0.784(95%CI:0.698-0.871,P<0.05);the optimal value was 20.01;the sensitivity was 66.67% and the specificity was 83.56 %;the positive predictive value was 80.22% and negative predictive value of 71.49%.Meanwhile,the positive likelihood ratio was 4.06 and the negative likelihood ratio was 0.40.The NLR was significantly associated with APACHE Ⅱ score(r=0.401,P<0.01),and the NLR of patients with APACHEⅡscore more than 20 were higher than those with APACHE Ⅱscore less than 20(19.41±6.93 vs.14.53±5.58,P<0.05).Conclusion: The increased NLR was an independently risk factor of 28-day mortality of patients with sepsis shock and it was significantly correlated with APACHEⅡscore.Therefore,NLR was useful for predicting prognosis of patients with sepsis shock.-
Key words:
- sepsis shock /
- neutrophil-to-lymphocyte ratio /
- predictive value /
- mortality
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[1] Zahorec R.Ratio of neutrophil to lymphocyte countsrapid and simple parameter of systemic inflammation and stress in critically ill[J].Bratisl Lek Listy,2001,102(1):5-14.
[2] Brait VH,Arumugam TV,Drummond GR,et al.Importance of T lymphocytes in brain injury,immunodeficiency,and recovery after cerebral ischemia[J].J Cereb Blood Flow Metab,2012,32(4):598-611.
[3] 陈辉,唐妮婷,王莉,等.高龄自发性脑出血患者中性粒细胞/淋巴细胞比值与其30d预后的关系[J].临床急诊杂志,2017,18(5):369-371.
[4] Jeon TJ,Park JY.Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis[J].World J Gastroenterol,2017,23(21):3883-3889.
[5] Singer M,Deutschman CS,Seymour CW,et al.The third international consensus definitions for sepsis and septic shock(sepsis-3)[J].JAMA,2016,315(8):801-810.
[6] Wesche DE,Lomas-Neira JL,Perl M,et al.Leukocyte apoptosis and its significance in sepsis and shock[J].J Leukoe Biol,2005,78(2):325-337.
[7] Jilma B,Blann A,Pemerstorfer T,et al.Regulation of adhesion molecules during human endotoxemia.No acute effects of aspirin[J].Am J Respir Crit Care Med,1999,159(3):857-863.
[8] de Jager CP,van Wijk PT,Mathoera RB,et al.Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit[J].Crit Care,2010,14(5):R192.
[9] Park JJ,Jang HJ,Oh IY,et al.Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarctionundergoing primary percutaneous coronary intervention[J].Am J Cardiol,2013,111(5):636-642.
[10] Balta I,Balta S,Demirkol S,et al.Neutrophil-to-lymphocyte ratio may predict subclinical atherosclerosis in patients with psoriasis[J].Echocardiography,2014,31(9):1166-1167.
[11] 林玲,蔡秀军,潘孔寒.外科危重病患者外周血淋巴细胞凋亡与预后的关系[J].中华危重病急救医学,2007,19(1):25-27.
[12] Felmet KA,Hall MW,Clark RS,et al.Prolonged lymphopenia,lymphoid depletion,and hypoprolactinemia in children with nosocomial sepsis and multiple organ failure[J].J Immunol,2005,174(6):3765-3772.
[13] Terradas R,Grau S,Blanch J,et al.Eosinophil count and neutrophil-lymphocyte count ratio as prognostic markers in patients with bacteremia:a retrospective cohort study[J].PLoS One,2012,7(8):e42860.
[14] de Jager CP,Wever PC,Gemen EF,et al.The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia[J].PLoS One,2012,7(10):e46561.
[15] Liu X,Shen Y,Wang H,et al.Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis:aprospective observational study[J].Mediators Inflamm,2016,2016:8191254.
[16] Hwang SY,Shin TG,Jo IJ,et al.Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients[J].Am J Emerg Med,2017,35(2):234-239.
[17] Salciccioli JD,Marshall DC,Pimentel MA,et al.The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness:an observational cohort study[J].Crit Care,2015,19(1):13.
[18] Riche F,Gayat E,Barthelemy R,et al.Reversal of neutrophil-tolymphocyte count ratio in early versus late death from septic shock[J].Crit Care,2015,19:439.
[19] 任艺,刘红梅,邵旦兵,等.MODS评分和APACHEⅡ评分对多脏器功能障碍综合征患者预后评价的比较[J].临床急诊杂志,2014,15(9):532-534.
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