中性粒细胞计数与淋巴细胞和血小板计数比值在儿童脓毒症预后中的预测价值

doi:10.3969/j.issn.1006-5725.2023.22.017

Abstract

Abstract:

Objective To investigate the predictive value of neutrophil to lymphocyte and platelet ratio （N/LPR） in the prognosis of children with sepsis. Methods Clinical data of 171 children with sepsis admitted to the pediatric intensive care unit （PICU） of the First Affiliated Hospital of Gannan Medical University from January 1st， 2018 to November 30th， 2022 were retrospectively collected. The pediatric clinical illness score （PCIS） within 24 hours after admission was recorded. Procalcitonin （PCT）， C-reactive protein （CRP） and platelet （PLT） count were collected within 24 hours after diagnosis of sepsis. N/LPR， platelet to lymphocyte ratio （PLR）， neutrophil to lymphocyte ratio （NLR）， and neutrophil to prealbumin ratio （NPRI） were calculated. According to the prognosis， the children were divided into survival group （n = 110） and death group （n = 61）. The difference of N/LPR， PLR， NLR， NPRI， PCIS， PCT， CRP and PLT was compared between the two groups. Receiver operating characteristic （ROC） curve was plotted to analyze the accuracy of N/LPR， PLR and PCIS in predicting 28-day mortality risk in children with sepsis. According to the cut-off value of ROC curve， the 28-day mortality risk of children was analyzed in the subgroups， and the Kaplan-Meier method was used to analyze the survival of children with sepsis in each subgroup. According to PCIS， children with sepsis were divided into three groups （non-critical group， critical group and extremely critical group）， and the relationship between N/LPR， PLR and disease severity was evaluated. Results The level of PCT， CRP and N/LPR in the death group were higher than that in the survival group， while the level of PLT， PLR and PCIS was lower than that in the survival group， and the difference was statistically significant （P < 0.05）. ROC curve showed that the area under curve （AUC） of N/LPR， PLR and PCIS for predicting the 28-day mortality risk of children with sepsis was 0.659， 0.595 and 0.716， respectively. Subgroup analysis showed that the risk of death in N/LPR ≥ 1.5 group was higher than that in N/LPR < 1.5 group （χ² = 11.224， P = 0.001）； that in PLR < 85.58 group was higher than that in PLR ≥ 85.58 group （χ² = 5.708， P = 0.017）； and that in PCIS ≥ 84 group was lower than that in PCIS < 84 group （χ² = 19.312， P = 0.000）. The result of survival analysis was consistent with that of subgroup analysis. In addition， N/LPR might be associated with the risk stratification in children with sepsis. Conclusion N/LPR has a certain predictive value for 28-day mortality risk in children with sepsis.

Key words: sepsis, neutrophil to lymphocyte and platelet ratio, prognosis, children

CLC Number:

R725.9

Chenyang CHANG,Shaowen HU,Guoping DENG,Huifang ZHU,Kaiyuan. LUO. Predictive value of neutrophil to lymphocyte and platelet ratio in prognosis of children with sepsis[J]. The Journal of Practical Medicine, 2023, 39(22): 2958-2963.

Figures/Tables 6

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References 35

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项目	总体（n = 171）	存活组（n = 110）	死亡组（n = 61）	P值
住院时间（d）	10.00（5.00，16.00）	11.00（8.00，16.25）	7.00（4.00，15.00）	0.001
呼吸（次/min）	32（26.00，40.00）	32.50（28.00，40.25）	29.00（24.00，41.00）	0.104
性别［例（%）］				< 0.001
女	64（37.4）	29（26.4）	35（57.4）
男	107（62.6）	81（73.6）	26（42.6）
心率（次/min）	135.00（121.00，155.00）	135.50（121.00，154.25）	134.00（120.00，159.50）	0.786
体温（℃）	37.3（36.7，38.4）	37.35（36.8，38.5）	37.30（36.70，38.25）	0.526
年龄［例（%）］				< 0.001
1个月 ~ 3岁	109（63.7）	85（77.3）	24（39.3）
3 ~ 7岁	32（18.7）	18（16.4）	14（23.0）
7 ~ 14岁	30（17.5）	7（6.4）	23（37.7）
主要感染部位［例（%）］				0.448
呼吸系统	78（45.6）	50（45.5）	28（45.9）
泌尿系统	7（4.1）	5（4.5）	2（3.3）
皮肤软组织	12（7.0）	6（5.5）	6（9.8）
胃肠道或腹腔	17（9.9）	14（12.7）	3（4.9）
中枢神经系统	47（27.5）	30（27.3）	17（27.9）
其他	10（5.8）	5（4.5）	5（8.2）

项目	存活组（n = 110）	死亡组（n = 61）	χ²/Z值	P值
PCT（ng/mL）	6.20（2.86，21.30）	14.20（5.68，48.67）	-2.486	0.013
CRP（mg/L）	43.74（12.05，86.15）	61.80（20.35，197.90）	-2.512	0.012
NLR	3.80（1.42，8.30）	3.92（1.15，9.08）	-0.119	0.905
NPRI	0.07（0.04，0.13）	0.09（0.02，0.17）	-0.216	0.829
PLT（10⁹/L）	281.50（197.75，382.75）	132.00（40.50，268.00）	-4.669	< 0.001
N/LPR	1.30（0.62，3.67）	3.03（1.33，7.70）	-3.424	0.001
PLR	130.65（74.94，255.78）	105.56（50.47，196.53）	-2.048	0.041
PCIS	92.00（86.00，96.00）	84.00（79.00，92.00）	-4.701	0.000

变量	AUC	P值	95%CI	敏感度（%）	特异度（%）	截断值
PCT	0.615	0.012	0.538 ~ 0.688	72.13	50.91	6.22
CRP	0.616	0.013	0.539 ~ 0.689	34.43	90.00	146.35
PLT	0.716	0.000	0.642 ~ 0.782	65.57	79.09	174
N/LPR	0.659	0.000	0.582 ~ 0.729	73.77	53.64	1.5
PLR	0.595	0.036	0.517 ~ 0.669	45.90	73.64	85.58
PCIS	0.716	0.000	0.642 ~ 0.782	52.46	80.91	84
PCIS+N/LPR	0.714	0.000	0.640 ~ 0.780	54.10	80.91	0.410
PCIS+PLR	0.724	0.000	0.650 ~ 0.789	50.82	85.45	0.462
PLR+N/LPR	0.571	0.119	0.493 ~ 0.646	75.41	40.00	0.359
PCIS+PLR+N/LPR	0.728	0.000	0.655 ~ 0.793	50.82	87.27	0.473

组别	例数	存活人数［例（%）］	死亡人数［例（%）］	χ²值	P值
N/LPR分组				11.224	0.001
N/LPR ≥ 1.5组	97	52（53.6）	45（46.4）
N/LPR < 1.5组	74	58（78.4）	16（21.6）
PLR分组				5.708	0.017
PLR ≥ 85.58组	115	81（70.4）	34（29.6）
PLR < 85.58组	56	29（51.8）	27（48.2）
PCIS评分分组				19.312	0.000
PCIS ≥ 84组	133	97（72.9）	36（27.1）
PCIS < 84组	38	13（34.2）	25（65.8）

组别	例数	N/LPR	PLR
非危重组	143	1.64（0.63，4.18）	120.66（67.98，244.79）
危重组	24	3.56（1.25，7.81）^*	108.05（68.15，210.42）
极危重组	4	7.39（1.57，22.14）	62.53（28.88，84.39）
H值		8.477	3.985
P值		0.014	0.136

Predictive value of neutrophil to lymphocyte and platelet ratio in prognosis of children with sepsis

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