【摘要】 目的 探讨中性粒细胞与淋巴细胞比值(NLR)联合急性生理与慢性健康状况评分系统(APACHEⅡ)评分、肺炎严重程度指数(PSI)评分和降钙素原(PCT)对重症肺炎(SP)死亡风险的预测价值。方法 回顾性分析258例SP患者的临床资料,依据住院28 d生存情况分为死亡组(81例)和存活组(177例),对比两组临床资料。采用多因素Logistic回归分析SP死亡的危险因素,绘制受试者工作特征曲线(ROC)评估NLR联合多因素对SP患者死亡的预测价值。结果 258例患者28 d死亡率为31.4%(81/258)。死亡组患者年龄(68.10±6.84)岁大于存活组的(65.87±6.41)岁,入重症加强护理病房(ICU)24 h的NLR 9.88(9.28, 10.13)、PCT(5.64±0.89)ng/ml、APACHEⅡ评分(22.35±1.63)分、PSI评分105(102, 120)分、使用血管活性药物占比27.2%高于存活组的8.84(8.01, 9.54)、(4.81±1.10)ng/ml、(20.35±1.56)分、73(68, 110)分、5.1%,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示：NLR、APACHEⅡ评分、PSI评分、PCT高是SP死亡的独立危险因素(P<0.05)。NLR、APACHEⅡ评分、PSI评分、PCT预测SP患者死亡的截断值分别为9.31、21.5分、97.5分、5.55 ng/ml;NLR联合多因素预测SP死亡的曲线下面积(AUC)0.940大于单一NLR、APACHEⅡ评分、PSI评分、PCT的0.740、0.806、0.755、0.762,差异有统计学意义(P<0.05)。NLR联合多因素预测SP死亡的灵敏度为92.60%,特异度为81.90%。结论 NLR联合APACHEⅡ评分、PSI评分、PCT等多因素对SP患者死亡风险有较高的预测价值。更多还原

【Abstract】 Objective To discuss the predictive value of neutrophil-to-lymphocyte ratio(NLR combined with acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), pneumonia severity index(PSI)score and procalcitonin(PCT) in the risk of death from severe pneumonia(SP). Methods The clinical data of 258SP patients were retrospectively analyzed, and they were divided into death group(81 cases) and survival group(177 cases) according to their 28-d hospitalization survival. The clinical data of the two groups were compared.Multivariate Logistic regression analysis was used to analyze the risk factors of death in SP patients, and receiver operating characteristic(ROC) curve was drawn to evaluate the predictive value of NLR combined with multiple factors on the death of SP patients. Results The 28-d mortality rate of 258 patients was 31.4%(81/258). In the death group, the age(68.10±6.84) years old was older than(65.87±6.41) years old in the survival group; the 24-h NLR for admission to the intensive care unit(ICU) 9.88(9.28, 10.13), PCT(5.64±0.89) ng/ml, APACHE Ⅱ score(22.35±1.63) points, PSI score 105(102, 120) points, percentage of vasoactive drugs used 27.2% were higher than 8.84(8.01, 9.54),(4.81±1.10) ng/ml,(20.35±1.56) points, 73(68, 110) points, 5.1% in the survival group; all the differences were statistically significant(P<0.05). Multivariate Logistic regression analysis showed that NLR, APACHE Ⅱ score, PSI score and high PCT were independent risk factors for SP death(P<0.05). The cut-off values of NLR, APACHE Ⅱ score, PSI score and PCT for predicting the death of SP patients were 9.31,21.5, 97.5 and 5.55 ng/ml. The area under the curve(AUC) of NLR combined with multiple factors to predict SP death was 0.940, which was greater than 0.740, 0.806, 0.755, and 0.762 of single NLR, APACHE Ⅱ score, PSI score, and PCT, and the differenceswere statistically significant(P<0.05). The sensitivity of NLR combined with multiple factors to predict SP death was 92.60% and the specificity was 81.90%. Conclusion NLR combined with APACHE Ⅱ score, PSI score, PCT have high predictive value on the risk of death in SP patients.更多还原