中性粒细胞/淋巴细胞比值联合随机血糖对脓毒症预测价值  

The predictive value of the neutrophils/lymphocytes ratio combined with random blood glucose in sepsis

作　　者：余广炜[1,2] 林增杰[1] 涂福泉 郑秋英[3] 项靖楠 魏增玉[1] 吴文伟 林晓红[1,2] Yu Guangwei;Lin Zengjie;Tu Fuquan;Zheng Qiuying;Xiang Jingnan;Wei Zengyu;Wu Wenwei;Lin Xiaohong(Emergency Department,Fujian Medical University Union Hospital,Fujian Key Laboratory of Vascular Aging,Fuzhou 350001,China;Fujian Key Laboratory of Vascular Aging(Fujian Medical University),Fuzhou 350001,China;First Clinical Medical College of Fujian Medical University,Fuzhou 350003,China)

机构地区：[1]福建医科大学附属协和医院急诊科,福州350001 [2]福建省血管衰老重点实验室(福建医科大学),福州350001 [3]福建医科大学第一临床医学院,福州350001

出　　处：《中华急诊医学杂志》2024年第5期636-642,共7页Chinese Journal of Emergency Medicine

基　　金：福建省教育厅中青年教师教育科研项目(JAT190190);福建医科大学启航基金(2019QH1049);福建省自然科学基金面上项目(2022J01728)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(ratio of neutrophil-lymphocyte,NLR)联合入院随机血糖对脓毒症患者血培养阳性的预测价值。方法采用单中心、回顾性队列研究方法,根据2016年美国危重病学会/欧洲危重病医学会脓毒症及脓毒性休克定义及诊断标准3.0收集2019年1月至2021年12月福建医科大学附属协和医院急诊科连续收治的住院时间大于24 h的脓毒症患者。统计入院时的年龄、性别、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、感染来源、中心粒细胞与淋巴细胞比值及血培养结果等。依据血培养结果将患者分为血培养阳性组(革兰阳性组,革兰阴性组),血培养阴性组,比较组间各指标差异。采用多因素logistic回归分析血培养阳性的独立危险因素。利用受试者工作曲线(receiver operating characteristic,ROC)评价NLR联合入院随机血糖对脓毒症患者血培养阳性的预测价值。结果共纳入脓毒症患者265例,其中62例血培养阳性(革兰阳性患者15例,革兰阴性患者37例,真菌患者10例),血培养阳性率为23.4%。血培养阳性组的糖尿病史患者数、中性粒细胞计数、降钙素原、血糖和NLR高于血培养阴性组(均P<0.001)。多因素Logistic回归分析显示,入院随机血糖(OR=1.116,95%CI:1.051~1.186,P<0.001)及NLR(OR=1.039,95%CI:1.015~1.064,P=0.001)是脓毒症患者血培养阳性的独立危险因素。对血培养阳性组及革兰阴性菌血流感染患者,NLR联合入院血糖的AUC分别为0.819(95%CI:0.761~0.877,P<0.001)和0.871(95%CI:0.813~0.928,P<0.001)。结论NLR联合入院随机血糖对脓毒症患者血培养阳性和革兰阴性菌血流感染均具有预测价值。Objective To explore the predictive value of the neutrophil-to-lymphocyte ratio(NLR)combined with blood glucose at admission for a positive blood culture for sepsis.Methods A single-center retrospective cohort study was conducted.According to the 2016 American Society of Critical Care/European Society of Critical Care Medicine(SCCM/ESICM)and diagnostic criteria for sepsis and septic shock-3.0(sepsis-3.0),patients with sepsis were admitted to the Emergency Department of Fujian Medical University Union Hospital for more than 24 h from January 2019 to December 2021 were enrolled.Age,gender,sequential organ failure assessment,source of infection,NLR,and blood culture results were recorded.Based on the blood culture results,patients were divided into a blood culture positive group(Gram-positive group,Gram-negative group)and blood culture negative group,and the differences between the groups were compared.The risk factors for a positive blood culture were analyzed using multivariate logistic regression.A receiver operating characteristic analysis was performed for the NLR combined with the blood glucose measurement.Results A total of 265 patients with sepsis were included,of which 62 were positive in blood culture(15 Gram-positive patients,37 Gram-negative patients and 10 fungal patients).The positive rate of blood culture was 23.4%.The number of patients with history of diabetes,neutrophil count,procalcitonin,blood glucose,and NLR in the positive blood culture group were significantly higher than those in the negative blood culture group(all P<0.001).Multivariate logistic regression analysis revealed that random admission blood glucose(OR=1.116,95%CI:1.051~1.186,P<0.001)and NLR(OR=1.039,95%CI:1.015~1.064,P=0.001)were independent risk factors for blood culture positivity in sepsis patients.For patients with blood culture positive,and with Gram-negative bacterial bloodstream infections,the AUC of the NLR combined with the admission blood glucose level was 0.819(95%CI:0.761-0.877,P<0.001)and 0.871(95%CI:0.813-0.928,P<0.0

关 键 词：血流感染 血培养 血糖 中性粒细胞与淋巴细胞比值 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]