The value of NLR combined with MPR in auxiliary diagnosis and evaluation of sepsis patients
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摘要: 目的 探讨中性粒细胞/淋巴细胞比值(NLR)联合平均血小板体积/血小板计数比值(MPR)对脓毒症患者辅助诊断及病情评估的价值。方法 回顾性分析2020年1月-2022年1月期间蚌埠医学院第一附属医院重症医学科(ICU)收治的142例感染患者的临床资料，依据脓毒症3.0诊断标准将患者分为脓毒症组(86例)、非脓毒症组(56例)。单因素和多因素logistic回归分析确定脓毒症发生的危险因素。Spearman相关性分析NLR、MPR、CRP、PCT与SOFA评分以及APACHEⅡ评分的相关性，评估NLR、MPR、CRP、PCT与脓毒症病情严重程度的相关性；应用受试者工作特征曲线(ROC)，评估NLR、MPR、CRP、PCT对脓毒症辅助诊断价值。结果 脓毒症组与非脓毒症组相比，NLR、MPR、CRP、PCT、APACHEⅡ评分、SOFA评分、病死率均明显升高，差异均具有统计学意义(均P < 0.05)。相关性分析显示：NLR、MPR、CRP、PCT与SOFA评分均呈强相关，其中以PCT与SOFA评分相关性最强，NLR、MPR、CRP、PCT与APACHEⅡ评分相关性较弱，NLR与APACHEⅡ评分中等强度相关。logistic回归分析结果表明NLR、MPR、CRP、PCT是脓毒症发生的危险因素。ROC曲线显示，NLR、MPR、CRP、PCT、NLR+MPR对脓毒症均有一定诊断价值(ROC曲线下面积分别为0.83、0.80、0.81、0.86，95%CI分别为0.76~0.90、0.73~0.87、0.73~0.88、0.80~0.92、0.80~0.93)，其中以PCT和NLR+MPR诊断效能最高，当NLR＝临界值13.05时，其敏感度和特异度分别为74.7%和82.1%，高于PCT＝临界值0.81 μg/L时的特异度和CRP＝临界值116.75 mg/L时的敏感度。结论 NLR、MPR可以作为脓毒症的辅助诊断的生物指标，NLR、MPR联合检测在识别脓毒症及其严重程度方面具有较高临床价值。
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关键词:
- 脓毒症 /
- 中性粒细胞/淋巴细胞比值 /
- 平均血小板体积/血小板计数比值 /
- 辅助诊断 /
- 病情评估
Abstract: Objective To investigate the value of neutrophils/lymphocyte ratio (NLR) combined with mean platelet volume-to-platelet count ratio(MPR) in the auxiliary diagnosis and disease evaluation of patients with sepsis.Methods The clinical data of 142 infected patients admitted to the Critical Care Department of Medicine(ICU) of the First Affiliated Hospital of Bengbu Medical College from January 2020 to January 2020 were retrospectively analyzed, and the patients were divided into sepsis(86) and non-sepsis(56) according to the diagnostic criteria of sepsis 3.0. Univariate and multivariate logistic regression analysis were used to identify the risk factors for the development of sepsis. Spearman correlation analyzed the correlation of NLR, MPR, CRP, PCT and SOFA score and APACHEⅡ score, evaluated the correlation of NLR, MPR, CRP, PCT and sepsis severity. Receiver operating characteristic curve (ROC) was applied to evaluate the auxiliary diagnosis value of NLR, MPR, CRP and PCT for sepsis.Results Compared with the non-sepsis group, NLR, MPR, CRP, PCT, APACHEⅡ score, SOFA score, and mortality were significantly increased in the sepsis group, with statistical significance (all P < 0.05). Correlation analysis showed that NLR, MPR, CRP and PCT were all strongly correlated with SOFA score, among which PCT was the most strongly correlated with SOFA score, NLR, MPR, CRP and PCT were weakly correlated with APACHEⅡ score, and NLR was moderately associated with APACHEⅡ score. logistic regression analysis showed that NLR, MPR, CRP and PCT were independent risk factors for sepsis. ROC curve showed that NLR, MPR, CRP, PCT and NLR+MPR all had certain diagnostic value for sepsis. The areas under ROC curve were 0.83, 0.80, 0.81 and 0.86, respectively. 95%CI was 0.76-0.90, 0.73-0.87, 0.73-0.88, 0.80-0.92, 0.80-0.93}, respectively. PCT and NLR+MPR had the highest diagnostic efficacy. When NLR=critical value 13.05, the sensitivity and specificity were 74.7% and 82.1%, respectively, which were higher than those when the critical value of CRP=116.75 mg/L.Conclusion NLR and MPR can be used as biological indicators for the auxiliary diagnosis of sepsis, and the combination detection of NLR and MPR has high clinical value in identifying sepsis and its severity. -
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表 1 两组患者一般资料比较
x±S 组别 性别/例 年龄/岁 病死率/% 男 女 非脓毒症组 30 26 65.71±14.13 14.3 脓毒症组 53 33 62.93±15.61 44.2 χ2/t 0.910 1.08 13.85 P 0.341 0.28 < 0.01 
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表 2 两组患者间实验室指标及严重程度评分比较
M(QL，QU), x±S 项目 非脓毒症组(56例) 脓毒症组(86例) U/t P NLR 8.13(6.49，12.29) 18.26(12.72，28.52) 6.69 < 0.01 MPR 0.04(0.03，0.06) 0.08(0.05，0.14) 5.35 < 0.01 CRP/(mg·L-1) 42.43(25.32，59.72) 183.50(59.18，217.00) 6.14 < 0.01 PCT/(ng·mL-1) 0.39(0.18，1.10) 6.54(1.88，22.24) 7.15 < 0.01 SOFA/分 5(3，6) 6(4，9) 3.39 < 0.01 APACHEⅡ/分 18.05±5.58 22.36±6.35 4.14 < 0.01
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表 3 脓毒症患者实验室指标与SOFA评分以及APACHEⅡ评分的相关性分析
指标 SOFA评分 APACHEⅡ评分 r P r P NLR 0.60 < 0.01 0.41 < 0.01 MPR 0.62 < 0.01 0.33 < 0.01 CRP 0.57 < 0.01 0.31 < 0.01 PCT 0.68 < 0.01 0.32 < 0.01
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表 4 Logistic回归分析脓毒症发生的危险因素
指标 β OR 95%CI P NLR 0.134 1.144 1.09~1.21 < 0.01 CRP 0.017 1.017 1.01~1.02 < 0.01 PCT 0.640 1.189 1.39~2.59 < 0.01
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表 5 实验室指标对脓毒症的辅助诊断价值
指标 临界值 敏感度/% 特异度/% AUC 95%CI P NLR 13.05 74.7 82.1 0.84 0.77~0.91 < 0.01 MPR 0.05 71.1 71.4 0.76 0.68~0.84 < 0.01 CRP 116.75 61.6 91.1 0.80 0.73~0.88 < 0.01 PCT 0.81 86.0 69.6 0.86 0.80~0.92 < 0.01 PCT+MPR 0.49 85.5 78.6 0.86 0.80~0.93 < 0.01
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