中性粒细胞与淋巴细胞比值联合序贯器官衰竭评分对烧伤脓毒症患者预后的评估价值  

Prognostic Value of Neutrophil to Lymphocyte Ratio Combined with Sequential Organ Failure Score in Patients with Burn Sepsis

作　　者：段媛媛 彭伟龙 曹阳 赵晗 DUAN Yuanyuan;PENG Weilong;CAO Yang(Graduate School of Guizhou Medical University,Guizhou 550004,China)

机构地区：[1]贵州医科大学麻醉学院,550004 [2]广州市红十字会医院麻醉科,510220 [3]广州市红十字会医院烧伤整形科,510220

出　　处：《医学研究杂志》2023年第10期122-126,168,共6页Journal of Medical Research

基　　金：广东省广州市科技计划项目(202201011728)。

摘　　要：目的 探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合序贯器官衰竭评分(sequential organ failure assessment,SOFA)对烧伤脓毒症患者预后的评估价值。方法 选择2021年1月~2022年4月在广州市红十字会医院烧伤科住院的烧伤脓毒症患者73例。根据患者28天的预后情况,分为存活组(52例)和死亡组(21例)。比较在入院时(T_(1))、脓毒症确诊时(T_(2))、脓毒症确诊后第3天(T_(3))3个时间点两组患者白细胞计数(white blood cell count,WBC)、降钙素原(procalcitonin,PCT)、NLR、SOFA评分和急性生理及慢性健康状况(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)评分的差别。同时分析在脓毒症确诊时(T_(2))PCT、NLR、SOFA评分、NLR联合SOFA评分预测烧伤脓毒症患者死亡的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)。结果 在T_(1)~T_(3) 3个时间点,WBC在存活组和死亡组间比较,差异无统计学意义(P>0.05);在T_(2)和T_(3)时间点,PCT在两组间比较差异有统计学意义(P<0.05);在T_(1)~T_(3)时间点,NLR在两组间比较差异有统计学意义(P<0.05);在T_(2)和T_(3)时间点,SOFA评分在两组间比较差异有统计学意义(P<0.05);在T_(3)时间点,APACHEⅡ评分在两组间比较差异有统计学意义(P<0.05)。在脓毒症确诊时(T_(3)),PCT预测烧伤脓毒症患者预后的ROC曲线下面积(AUC)为0.697(P=0.010),阈值为14.145(敏感度为72.0%,特异性为87.5%);NLR预测效能的AUC为0.761(P<0.001),阈值是11.465(敏感度为81.0%,特异性为75.5%);SOFA评分预测效能的AUC为0.715(P=0.004),阈值为10.500(敏感度为75.0%,特异性为78.1%);NLR与SOFA评分联合预测时,AUC为0.890(P<0.001),预测效果优于其中任何一项单独预测时的效能。结论 NLR和SOFA评分是烧伤脓毒症患者死亡的独立危险因素,两者联合预测烧伤脓毒症患者死亡风险时,其预测能力明显提高,为临床工作提供一定的指导。Objective To evaluate the value of neutrophil to lymphocyte ratio(NLR)combined with Sequential Organ failure assessment(SOFA)in the prognosis of burn sepsis patients.Methods Seventy-three patients with burn sepsis who were hospitalized in the burn department of Guangzhou Red Cross Hospital from January 2021 to April 2022 were selected.According to prognosis of patients after 28days,patients were divided into survival group(52 cases)and death group(21 cases).The differences of white blood cell count(WBC),procalcitonin(PCT),NLR,SOFA score and Acute Physiological and Chronic Health Evaluation(APACHEⅡ)score were compared between the two groups at three time points:after admission(T_(1)),diagnosis of sepsis(T_(2)),and 3days after diagnosis of sepsis(T_(3)).The area under ROC curve(AUC)of PCT,NLR,SOFA score and NLR combined SOFA score in predicting death of burn sepsis patients at T_(2) were analyzed.Results At T_(1),T_(2) and T_(3),there was no significant difference in WBC between survival group and death group(P>0.05);at T_(2) and T_(3),significant differences of PCT between the two groups were observed(P<0.05);at T_(1),T_(2) and T_(3),significant differences of NLR between the two groups were observed(P<0.05);at T_(2) and T_(3),significant differences of SOFA scores were observed(P<0.05);at T_(3),significant differences of APACHEⅡscores were observed(P<0.05).At T_(3),the AUC of PCT for predicting the prognosis of burn sepsis patients was 0.697(P=0.010),and the threshold was 14.145(sensitivity 72%,specificity 87.5%).The AUC of NLR in predicting the performance was 0.761(P<0.001),the threshold was 11.465(sensitivity 81%,specificity 75.5%);the AUC of SOFA score was 0.715(P=0.004),and the threshold was 10.500(sensitivity 75%,specificity 78.1%).When NLR and SOFA score were combined,the AUC was 0.890(P<0.001),which is better than either prediction alone.Conclusion NLR and SOFA score are independent risk factors for the death of burn sepsis patients,and the predictive ability can be significantly improved by combining

关 键 词：中性粒细胞/淋巴细胞比值 序贯器官衰竭评分 烧伤脓毒症 预后 

分 类 号：R446.1[医药卫生—诊断学] R644[医药卫生—临床医学]