24h血乳酸清除率联合NLR、PCT对重症监护病房重症肺炎28d病死风险的预测价值分析  

Predictive value of 24 h blood lactate clearance combined with NLR and PCT on 28 day mortality risk of severe pneumonia in ICU

作　　者：褚明永 刘如喜[1] 付理想 丁莉[1] 童飞 Chu Ming-yong;Liu Ru-xi;Fu Li-xiang;Ding Li;Tong Fei(General Hospital of Wanbei Coal-Electricity Group,Suzhou,Anhui 234000,China;The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui 230036,China)

机构地区：[1]安徽皖北煤电集团总医院,安徽宿州234000 [2]中国科学技术大学附属第一医院(安徽省立医院),安徽合肥230036

出　　处：《中国现代医学杂志》2023年第17期57-61,共5页China Journal of Modern Medicine

基　　金：安徽省自然科学基金(No:1808085MH228,No:2008085QH354)。

摘　　要：目的研究24h血乳酸(Lac)清除率联合外周血中性粒细胞与淋巴细胞比值(NLR)、降钙素原(PCT)对重症监护病房(ICU)重症肺炎患者28 d病死风险的预测价值。方法回顾性选取2017年12月—2021年12月安徽皖北煤电集团总医院78例重症肺炎患者作为研究对象,根据28d临床结局将其分为病死组27例和存活组51例。比较两组的一般资料、24hLac清除率、NLR、PCT,采用多因素一般Logistic回归模型分析28d内病死的影响因素,采用受试者工作特征(ROC)曲线评估24hLac清除率联合NLR、PCT对28d内病死风险的预测价值。结果两组的性别、年龄、吸烟史、基础疾病、氧合指数、体温、平均动脉压、白细胞计数、血小板计数、抗菌药物使用时间比较,差异均无统计学意义(P>0.05);病死组肺炎严重程度评分(PSI)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、机械通气治疗占比均高于存活组(P<0.05);病死组24 h Lac清除率低于存活组,NLR、PCT水平高于存活组(P<0.05);经多因素一般Logistic回归分析,PSI评分[O^R=9.440(95%CI:4.108,21.697)]、APACHEⅡ评分[O^R=3.904(95%CI:1.699,8.972)]、24 h Lac清除率[O^R=5.068(95%CI:2.205,11.648)]、NLR[O^R=8.199(95%CI:3.567,18.843)]、PCT[O^R=5.766(95%CI:2.509,13.252)]均为28 d内病死的影响因素(P<0.05);ROC曲线分析结果显示,24 h Lac清除率、NLR、PCT预测28 d内病死的最佳截断值为26.10%、5.95和11.27μg/L,敏感性为81.48%(95%CI:0.613,0.930)、59.26%(95%CI:0.390,0.770)、66.67%(95%CI:0.460,0.828),特异性为72.55%(95%CI:0.580,0.837)、82.35%(95%CI:0.686,0.911)、90.20%(95%CI:0.778,0.963),AUC值为0.809(95%CI:0.704,0.889)、0.736(95%CI:0.624,0.830)、0.802(95%CI:0.697,0.884),联合预测的敏感性为92.59%(95%CI:0.742,0.987)、特异性为86.27%(95%CI:0.731,0.938)、AUC值为0.946(95%CI:0.871,0.985)。结论ICU重症肺炎28 d内病死患者的24 h Lac清除率、NLR、PCT明显异常变化,其对预后评估具有良好预测价值。Objective To study the predictive value of 24-hour blood lactic acid(LAC)clearance combined with peripheral blood neutrophil lymphocyte ratio(NLR)and procalcitonin(PCT)on the 28 day death risk of severe pneumonia in intensive care unit(ICU).Methods Seventy-eight patients with severe pneumonia in General Hospital of Wanbei Coal-Electricity Group from December 2017 to December 2021 were selected as the research object,and they were divided into death group(n=27)and survival group(n=51)according to the 28 day death.The general data,24 h lac clearance,NLR and PCT of the two groups were compared.The influencing factors of death within 28 d were analyzed by logistic regression,and the predictive value of 24 h lac clearance combined with NLR and PCT on the risk of death within 28 d was evaluated by ROC.Results There was no significant difference between the two groups in gender,age,smoking history,basic diseases,oxygen and index,body temperature,map,WBC,PLT and the use time of antibiotics(P>0.05).The PSI score,ApacheⅡscore and the proportion of mechanical ventilation treatment in the death group were higher than those in the survival group(P<0.05).The 24 h lac clearance rate in the death group was lower than that in the survival group,and the levels of NLR and PCT were higher than those in the survival group(P<0.05).Logistic regression analysis showed that PSI score[O^R=9.440(95%CI:4.108,21.697)],ApacheⅡscore[O^R=3.904(95%CI:1.699,8.972)],24 h lac clearance rate[O^R=5.068(95%CI:2.205,11.648)],NLR[O^R=8.199(95%CI:3.567,18.843)]and PCT[O^R=5.766(95%CI:2.509,13.252)]were the influencing factors of death within 28 d(P<0.05).ROC analysis showed that the cut off values of 24-hour lac clearance,NLR and PCT predicted death within 28 days were 26.10%,5.95 and 11.27μg/L;the sensitivity was 81.48%(95%CI:0.613,0.930),59.26%(95%CI:0.390,0.770),and 66.67%(95%CI:0.460,0.828),respectively;the specificity was 72.55%(95%CI:0.580,0.837),82.35%(95%CI:0.686,0.911),90.20%(95%CI:0.78,0.963),respectively;the AUC values were 0.809(95%CI:0.

关 键 词：重症肺炎 重症监护病房 24 h血乳酸清除率 中性粒细胞与淋巴细胞比值 降钙素原 28 d病死风险 预测价值 

分 类 号：R563.1[医药卫生—呼吸系统]