Liberski Piotr S, Szewczyk Michał, Krzych Łukasz J
Department of Anaesthesiology and Intensive Care, Faculty of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland.
Diagnostics (Basel). 2020 Aug 27;10(9):638. doi: 10.3390/diagnostics10090638.
This study aimed (1) to assess the diagnostic accuracy of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR) and platelet count-to-mean platelet volume (PLT/MPV) ratios in predicting septic shock in patients on admission to the intensive care unit (ICU) and (2) to compare it with the role of C-reactive protein (CRP), procalcitonin (PCT) and lactate level. We also sought (3) to verify whether the indices could be useful in ICU mortality prediction and (4) to compare them with Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores. This retrospective study covered 138 patients, including 61 subjects with multi-organ failure due to septic shock (study group) and 77 sex- and age-matched controls. Septic patients had significantly higher NLR ( < 0.01) and NLR predicted septic shock occurrence (area under the ROC curve, AUROC = 0.66; 95% CI 0.58-0.74). PLR, MLR and PLT/MPV were impractical in sepsis prediction. Combination of CRP with NLR improved septic shock prediction (AUROC = 0.88; 95% CI 0.81-0.93). All indices failed to predict ICU mortality. APACHE II and SAPS II predicted mortality with AUROC = 0.68; 95% CI 0.54-0.78 and AUROC = 0.7; 95% CI 0.57-0.81, respectively. High NLR may be useful to identify patients with multi-organ failure due to septic shock but should be interpreted along with CRP or PCT. The investigated indices are not related with mortality in this specific clinical setting.
（1）评估中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）以及血小板计数与平均血小板体积比值（PLT/MPV）在预测重症监护病房（ICU）患者入院时感染性休克方面的诊断准确性；（2）将其与C反应蛋白（CRP）、降钙素原（PCT）和乳酸水平的作用进行比较。我们还试图：（3）验证这些指标是否有助于预测ICU死亡率；（4）将它们与急性生理与慢性健康状况评分系统II（APACHE II）、简化急性生理学评分II（SAPS II）和序贯器官衰竭评估（SOFA）评分进行比较。这项回顾性研究涵盖了138名患者，包括61名因感染性休克导致多器官功能衰竭的患者（研究组）和77名性别与年龄匹配的对照组。感染性休克患者的NLR显著更高（<0.01），且NLR可预测感染性休克的发生（ROC曲线下面积，AUROC = 0.66；95%可信区间0.58 - 0.74）。PLR、MLR和PLT/MPV在脓毒症预测中不实用。CRP与NLR联合使用可改善感染性休克的预测（AUROC = 0.88；95%可信区间0.81 - 0.93）。所有指标均未能预测ICU死亡率。APACHE II和SAPS II预测死亡率的AUROC分别为0.68；95%可信区间0.54 - 0.78和AUROC = 0.7；95%可信区间0.57 - 0.81。高NLR可能有助于识别因感染性休克导致多器官功能衰竭的患者，但应结合CRP或PCT进行解读。在这一特定临床环境中所研究的指标与死亡率无关。
