中性粒细胞与淋巴细胞比值联合乳酸对老年脓毒症患者预后的评估价值  

Value of Neutrophil to Lymphocyte Ratio Combined with Lactic Acid in the Prognosis of Elderly Patients with Sepsis

作　　者：袁娜娜[1] 章晋辉 尹江涛[1] 张德厚[1] YUAN Nana;ZHANG Jinhui;YIN Jiangtao;ZHANG Dehou(Department of Critical Care Medicine,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu Province,212000 China)

机构地区：[1]江苏大学附属医院重症医学科,江苏镇江212000

出　　处：《系统医学》2022年第24期37-41,共5页Systems Medicine

基　　金：2020年度镇江市科技创新资金(重点研发计划-社会发展)项目(SH2020057)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合乳酸对老年脓毒症患者预后的评估价值。方法回顾性分析2020年12月—2021年12月江苏大学附属医院重症医学科收治的115例脓毒症患者,按照患者28 d生存情况分为死亡组(34例)与生存组(81例)。比较两组老年脓毒症患者年龄、性别、糖尿病、高血压和感染部位及NLR、血清乳酸水平。分析影响患者预后的危险因素,绘制受试者工作特征(ROC)曲线,分析危险因素对老年脓毒症患者预后的评估价值。结果两组患者年龄、性别、糖尿病、高血压和感染部位比较,差异无统计学意义(P>0.05)。死亡组患者NLR和乳酸水平高于生存组,差异有统计学意义(P<0.05);NLR和血清乳酸水平是老年脓毒症患者预后的独立危险因素。NLR预测患者预后的ROC曲线下面积(AUC)为0.897,最佳截断值26.125(敏感度82.40%,特异度82.70%);乳酸预测患者预后的AUC为0.845,最佳截断值3.720(敏感度94.10%,特异度75.30%);当两者联合预测时,AUC为0.947,优于任何单一指标对老年脓毒症患者28 d预后的预测作用。结论NLR及血清乳酸水平是预测老年脓毒症患者死亡的独立危险因素;当两者联合预测死亡风险时,可以明显提高准确性。Objective To investigate the prognostic value of neutrophil to lymphocyte ratio(NLR)combined with lactic acid in elderly patients with sepsis.Methods 115 patients with sepsis admitted to the Department of Critical Care Medicine,Affiliated Hospital of Jiangsu University from December 2020 to December 2021 were retrospectively analyzed.According to the 28 d survival,the patients were divided into death group(34 cases)and survival group(81 cases).The age,gender,diabetes,hypertension,infection site,NLR and serum lactate level of the two groups of elderly sepsis patients were compared.The risk factors affecting the prognosis of patients were analyzed,receiver operating characteristic(ROC)curve was drawn,and the evaluation value of risk factors on the prognosis of elderly patients with sepsis was analyzed.Results The age,sex,diabetes,hypertension and infection site of the two groups were compared,the difference was not statistically significant(P>0.05).The levels of NLR and lactic acid in death group were higher than those in survival group,and the difference was statistically significant(P<0.05).NLR and serum lactic acid levels were independent risk factors for prognosis in elderly patients with sepsis.The area under ROC curve(AUC)of NLR was 0.897,and the optimal cut-off value was 26.125(sensitivity 82.40%,specificity 82.70%).The AUC of lactic acid was 0.845,and the optimal cut-off value was 3.720(sensitivity 94.10%,specificity 75.30%).When combined,the AUC was 0.947,which was better than any single index in predicting the prognosis of senile sepsis patients at 28 days.Conclusion NLR and serum lactic acid level are independent risk factors for predicting death in senile sepsis patients.When the two combined predicted the risk of death,the accuracy improved significantly.

关 键 词：脓毒症 老年人 中性粒细胞/淋巴细胞比值 乳酸 

分 类 号：R4[医药卫生—临床医学]