Wu Haotian, Li Chunxia, Liu Song, Yao Shuangquan, Song Zhaohui, Ren Dong, Wang Pengcheng
Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
Department of Imaging Medicine, General Hospital of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia, 010017, People's Republic of China.
Infect Drug Resist. 2023 Jun 16;16:3861-3870. doi: 10.2147/IDR.S413126. eCollection 2023.
Neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and red blood cell distribution width (RDW) are novel biomarkers to indicate the inflammatory/immune response, and demonstrated to be effective in diagnosis, severity evaluation, and prognosis in a variety of chronic or acute conditions. This study aims to examine whether NLR, PLR and EDW are independently associated with mortality in necrotizing fasciitis (NF).
This study retrospectively enrolled patients diagnosed with NF and based on vitality status during hospitalization or within 30 days after discharge, survival and non-survival groups were defined. For distinctly comparing NLR, PLR, RDW and others, we enrolled the matched healthy controls of the same age and sex as the survivors of NF in a 1:1 ratio, which constituted the healthy control group. Comparisons were made between three groups. Variables tested with a value < 0.10 were further entered into the multivariate logistic regression model to identify their independent association with mortality.
A total of 281 subjects were included, including 127 healthy controls, 127 survivors, and 27 nonsurvivors with NF, respectively, indicating a mortality rate of 17.5%. ROC analysis showed that the optimal cutoff value for NLR, PLR and RDW was 11.1, 196.0 and 15.5%, respectively, and was tested as significant only for the first two (P < 0.001, = 0.004). Multivariate logistic analysis showed that NLR ≥ 11.1 (OR, 2.51) and PLR ≥ 196.0 (OR, 2.09) were independently associated with an increased risk of mortality in NF patients, together with age ((OR, 1.28, for each 10-year increment), comorbid diabetes mellitus (OR, 2.69) and liver disease (OR, 1.86), and elevated creatinine level (OR, 1.21 for each 10 umol/L elevation).
Elevated NLR and PLR are significant and independent predictors of mortality and can be considered for use when evaluating patients at risk of mortality.
中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）以及红细胞分布宽度（RDW）是提示炎症/免疫反应的新型生物标志物，已证实在各种慢性或急性疾病的诊断、严重程度评估及预后判断中具有重要作用。本研究旨在探讨NLR、PLR及RDW是否与坏死性筋膜炎（NF）患者的死亡率独立相关。
本研究回顾性纳入诊断为NF的患者，根据住院期间或出院后30天内的生命状态，将患者分为存活组和非存活组。为了更清晰地比较NLR、PLR、RDW及其他指标，我们按照1:1的比例纳入与NF存活者年龄和性别匹配的健康对照，组成健康对照组。对三组进行比较。将P值<0.10的变量进一步纳入多因素逻辑回归模型，以确定它们与死亡率的独立相关性。
共纳入281名受试者，分别包括127名健康对照、127名存活者及27名NF非存活者，死亡率为17.5%。ROC分析显示，NLR、PLR及RDW的最佳截断值分别为11.1、196.0及15.5%，仅前两者具有统计学意义（P<0.001，P = 0.004）。多因素逻辑分析显示，NLR≥11.1（OR，2.51）和PLR≥196.0（OR，2.09）与NF患者死亡风险增加独立相关，同时还包括年龄（每增加10岁，OR，1.28）、合并糖尿病（OR，2.69）、肝脏疾病（OR，1.86）以及肌酐水平升高（每升高10 μmol/L，OR，1.21）。
NLR和PLR升高是死亡率的重要独立预测因素，在评估有死亡风险的患者时可考虑使用。
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