Liu Dadong, Yu Zongying, Zhang Dehou, Zhang Jianguo, Zhang Yafeng, Wang Xu
Department of Intensive Care Unit, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu, China.
Department of Electrocardiograph, the 4th Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Jan;33(1):33-37. doi: 10.3760/cma.j.cn121430-20200727-00545.
To evaluate the value of neutrophil to lymphocyte and platelet ratio (N/LPR) for predicting 28-day mortality in sepsis patients.
A retrospective analysis was conducted. The clinical data of 154 sepsis patients admitted to intensive care unit (ICU) of the Affiliated Hospital of Jiangsu University from June 2017 to June 2020 were enrolled. The time of first diagnosis of sepsis in ICU was taken as the research starting point, and the death or 28 days as the end point. The 28-day outcomes of patients were recorded. The counts of peripheral blood neutrophil (NEU), lymphocyte (LYM) and platelet (PLT) were collected from all the enrolled patients within 3 days after diagnosis of sepsis. The ratios of N/LPR and NEU/LYM (NLR) were calculated respectively. The differences of N/LPR and NLR between survival group and death group were compared. Receiver operating characteristic (ROC) curve analysis was used to analyze the value of N/LPR and NLR on predicting the 28-day mortality of sepsis patients. According to the best cut-off value of ROC curve analysis, the 28-day mortality of patients with sepsis was analyzed by subgroup analysis, and the 28-day cumulative survival of patients with sepsis was analyzed by Kaplan-Meier survival curve.
Of the 154 sepsis patients, the patients with age < 18 years, pregnancy, blood disease, taking aspirin or other antiplatelet drugs within 1 week, taking leucocyte drugs within 1 week, length of ICU stay < 3 days and incomplete data were excluded. Finally, 50 patients were enrolled. Among them, 30 patients survived on the 28th day and 20 died. Compared with the survival group, the levels of N/LPR and NLR in the death group were significantly increased (N/LPR: 23.85±11.99 vs. 12.41±5.25, NLR: 17.83±8.69 vs. 10.75±3.63), with statistical differences (both P < 0.01). ROC curve analysis indicated that the area under ROC curve (AUC) of N/LPR for predicting 28-day death of sepsis patients was 0.827, it was higher than that of NLR (AUC = 0.762). Base on N/LPR ≥ 15.48 as a predictor of cut-off value of death in 28 days of sepsis patients, the sensitivity was 75.0% and the specificity was 80.0%, respectively. Base on NLR ≥ 10.65 as a predictor of cut-off value of death in 28 days of sepsis patients, the sensitivity was 75.0% and specificity was 56.7%, respectively. Subgroup analysis showed that the 28-day mortality in the patients with N/LPR ≥ 15.48 (n = 21) was significantly higher than those with N/LPR < 15.48 (n = 29; 71.4% vs. 17.2%, χ = 14.901, P < 0.01); and the 28-day mortality in the patients with NLR ≥ 10.65 (n = 28) was also significantly higher than those with NLR < 10.65 (n = 22; 53.6% vs. 22.7%, χ = 4.884, P < 0.05). The results were consistent with Kaplan-Meier survival curve analysis.
Peripheral blood N/LPR has a good predictive value for 28-day mortality of sepsis patients, and which is better than NLR.
评估中性粒细胞与淋巴细胞及血小板比值（N/LPR）对脓毒症患者28天死亡率的预测价值。
进行回顾性分析。纳入2017年6月至2020年6月在江苏大学附属医院重症监护病房（ICU）收治的154例脓毒症患者的临床资料。以在ICU首次诊断脓毒症的时间作为研究起点，以死亡或28天为终点。记录患者的28天结局。在脓毒症诊断后3天内收集所有纳入患者的外周血中性粒细胞（NEU）、淋巴细胞（LYM）和血小板（PLT）计数。分别计算N/LPR和中性粒细胞与淋巴细胞比值（NLR）。比较存活组和死亡组N/LPR和NLR的差异。采用受试者工作特征（ROC）曲线分析评估N/LPR和NLR对预测脓毒症患者28天死亡率的价值。根据ROC曲线分析的最佳截断值，通过亚组分析脓毒症患者的28天死亡率，并采用Kaplan-Meier生存曲线分析脓毒症患者的28天累积生存率。
154例脓毒症患者中，排除年龄<18岁、妊娠、血液系统疾病、1周内服用阿司匹林或其他抗血小板药物、1周内服用升白细胞药物、ICU住院时间<3天及数据不完整的患者。最终纳入50例患者。其中，30例患者在第28天存活，20例死亡。与存活组相比，死亡组的N/LPR和NLR水平显著升高（N/LPR：23.85±11.99 vs. 12.41±5.25，NLR：17.83±8.69 vs. 10.75±3.63），差异有统计学意义（均P<0.01）。ROC曲线分析表明，N/LPR预测脓毒症患者28天死亡的ROC曲线下面积（AUC）为0.827，高于NLR（AUC = 0.762）。以N/LPR≥15.48作为脓毒症患者28天死亡的预测截断值，敏感性和特异性分别为75.0%和80.0%。以NLR≥10.65作为脓毒症患者28天死亡的预测截断值，敏感性和特异性分别为75.0%和56.7%。亚组分析显示，N/LPR≥15.48的患者（n = 21）28天死亡率显著高于N/LPR<15.48的患者（n = 29；71.4% vs. 17.2%，χ = 14.901，P<0.01）；NLR≥10.65的患者（n = 28）28天死亡率也显著高于NLR<10.65的患者（n = 22；53.6% vs. 22.7%，χ = 4.884，P<0.05）。结果与Kaplan-Meier生存曲线分析一致。
外周血N/LPR对脓毒症患者28天死亡率有良好的预测价值，且优于NLR。
