摘要
目的 探讨中性粒细胞与淋巴细胞比值(NLR)结合红细胞分布宽度(RDW)对急诊老年脓毒症病人疾病严重程度和预后的评估意义。方法 收集2019年1月到2022年2月在首都医科大学宣武医院急诊科就诊及住院治疗的老年脓毒症病人169例。病人入急诊后给予生化全项、血气分析、全血细胞计数、降钙素原(PCT)、胸部计算机体层摄影(CT)、病原学检查等。依据以上检查结果进行急性生理与慢性健康状况评估(APACHEⅡ)。根据病人入急诊时合并脓毒性休克情况分为脓毒症组114例和脓毒性休克组55例。随访28 d,依据病人死亡情况分成生存组125例和死亡组44例。分别比较脓毒性休克组和脓毒症组、生存组和死亡组病人NLR、白细胞计数(WBC)、PCT、RDW和APACHEⅡ评分的区别,进行NLR、RDW与PCT及APACHEⅡ评分的相关性分析;分析RDW、NLR及2个指标相互结合评估老年脓毒症病人死亡风险的受试者工作特征曲线下面积(AUC)和PCT曲线下面积的区别。结果 脓毒症休克组病人PCT、NLR、RDW和APACHEⅡ评分分别为(1.86±1.04)μg/L、9.63±3.92、(14.95±3.49)%和(16.75±3.53)分,均明显高于脓毒症组的(1.38±1.06)μg/L、7.87±3.94、(12.74±3.83)%、(14.61±2.87)分(P<0.01);WBC在脓毒症死亡组与生存组比较差异无统计学意义(P=0.361),死亡组APACHEⅡ评分、NLR、PCT和RDW分别为(18.52±2.41)分、(10.64±3.74)、(2.55±1.14)μg/L和(15.98±3.69)%,均大于生存组的(14.17±2.71)分、7.67±3.82、(1.19±0.81)μg/L、(12.57±3.43)%(P<0.01),RDW和NLR均与APACHEⅡ评分和PCT具有相关性(均P<0.01);PCT的AUC 95%CI为0.86(0.80,0.92),APACHEⅡ评分的AUC 95%CI为0.88(0.83,0.93),RDW的AUC 95%CI为0.75(0.66,0.83),NLR的AUC95%CI为0.73(0.64,0.81),RDW和NLR的AUC均小于PCT(P=0.048,0.024),但RDW与NLR联合的AUC为0.80,与PCT比较差异无统计学意义(P=0.363)。结论 NLR及RDW两个指标都能够在急诊老年脓毒症病人的病情和预后评估中有较好的应用价值,二者联合的应用价值与PCT相近。
Objective To study the value of neutrophil to lymphocyte rate(NLR)combined with red blood cell distribution width(RDW)in evaluating the condition and prognosis of elderly sepsis patients in emergency.Methods One hundred and sixty-nine elder-ly sepsis patients in the Department of Emergency,Xuanwu Hospital of Capital Medical University from January 2019 to February 2022 were accumulated.After entering the emergency department,biochemical examination,blood gas analysis,blood routine examina-tion,procalcitonin(PCT),chest computer tomography(CT),etiological examination and other examinations were given,the acute physi-ology and chronic health evaluation(APACHEⅡ)scores were scored according to the inspection results.According to the patient's concurrent septic shock at the time of admission to the emergency department,there were 114 cases of sepsis and 55 cases of septic shock.After 28 days of follow-up,the patients were separated into a survival group of 125 cases and a death group of 44 cases.The dif-ferences of PCT,white blood cell count(WBC),NLR,APACHEⅡscores and RDW were compared between sepsis group and septic shock group,the differences of those were also compared between the death group and the survival group.The correlation between NLR,RDW and APACHEⅡscores,PCT were analyzed.The difference of area under receiver operating characteristic curve(AUC)of RDW,NLR,their combination and PCT in predicting death were compared in elderly sepsis patients.Results The PCT,NLR,RDW,and APACHEⅡscores of patients in the septic shock group were respectively(1.86±1.04)µg/L,9.63±3.92,(14.95±3.49)%and(16.75±3.53)points,these indicators were significantly higher than the sepsis group[PCT(1.38±1.06)µg/L,NLR(7.87±3.94),RDW(12.74±3.83)%and APACHEⅡscores(14.61±2.87)points](P<0.01).The difference of WBC was not obvious between the survival group and the death group(P=0.361).The APACHEⅡscore,NLR,PCT and RDW of the death group were(18.52±2.41)points,10.64±3.74,(2.55±1.14)µg/L and(15.98±3.69)%respectively,these indicators were all higher than the survival group[APACHEⅡscore(14.17±2.71)points,NLR(7.67±3.82),PCT(1.19±0.81)µg/L and RDW(12.57±3.43)%](P<0.01).The RDW and NLR were correlated with APACHEⅡscores and PCT(all P<0.01).The AUC 95%CI of PCT in predicting death was 0.86(0.80,0.92),the AUC of APACHEⅡscores was 0.88(0.83,0.93),the AUC of RDW was 0.75(0.66,0.83),and the AUC of NLR was 0.73(0.64,0.81).The AUC of RDW and NLR was smaller than that of PCT(P=0.048,0.024),but the AUC of RDW combined with NLR was 0.80,which had no significant difference compared with PCT(P=0.363).Conclusion Both NLR and RDW indicators have good application value in the evaluation of the condition and prognosis of elderly sepsis patients,the combined evaluation value of the two indicators is similar to that of PCT.
作者
杨海龙
王冬利
刘燕平
王晶
王长远
YANG Hailong;WANG Dongli;LIU Yanping;WANG Jing;WANG Changyuan(Department of Emergency,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
出处
《安徽医药》
CAS
2024年第4期676-680,共5页
Anhui Medical and Pharmaceutical Journal
基金
国家重点研发计划课题(2020YFC2005402)。
关键词
脓毒症
红细胞分布宽度
中性粒细胞与淋巴细胞比值
降钙素原
急性生理与慢性健康状况评估
老年人
Sepsis
Red blood cell distribution width(RDW)
Neutrophil to lymphocyte ratio(NLR)
Procalcitonin(PCT)
Acute physiology and chronic health evaluation(APACHEⅡ)
Aged
