入院后全身炎症指标预测大面积烧伤患者的院内死亡率。

The systemic inflammation indexes after admission predict in-hospital mortality in patients with extensive burns.

机构信息

Department of Burns and Plastic Surgery, the third Xiangya Hospital, Central South University, Changsha, China.

出版信息

Burns. 2024 May;50(4):980-990. doi: 10.1016/j.burns.2024.01.020. Epub 2024 Jan 20.

DOI:10.1016/j.burns.2024.01.020

PMID:38336497

Abstract

PURPOSE

To explore the clinical value of various complete blood count (CBC)-derived inflammation indicators to predict in-hospital mortality in patients with extensive burns.

METHODS

Systemic inflammation indexes, including lymphocyte-platelet ratio (LPR), neutrophil-lymphocyte ratio (NLR), neutrophil-monocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), neutrophil-to-lymphocyte * platelet (NLPR), systemic inflammation index (SII), and systemic inflammation response index (SIRI) on days 1, 3, and 7 after admission were calculated in 135 patients with extensive burns.

RESULTS

We included 135 patients with extensive burns, including 97 survivors and 38 non-survivors. After adjusting for confounders, only the LPR on day 1, NLPR on days 3 and 7 were significantly associated with survival (OR= 1.237, 1.097, 1.104; 95 % CI: 1.055-1.451, 1.002-1.202, 1.005-1.212; respectively) in the analysis of multivariate logistic regression. The optimum cutoff values of the LPR on day 1 and NLPR on day 3 were 6.37 and 8.06, and the area under the curves (AUC) were 0.695 and 0.794, respectively. The AUC of NLPR on day 7 had the highest value, 0.814, and the optimum cut-off value was 3.84. The efficacy of LPR on day 1, NLPR on days 3 and 7 combined with the burn prognostic score index in predicting the prognosis of patients was higher than that of the burn index alone, and the three composite inflammatory indexes combined with PBI had the highest efficacy in predicting the prognosis (AUC = 0.994). Kaplan-Meier survival analysis showed poor prognosis in patients with higher LPR on day 1 and higher NLPR on days 3 and 7 (log-rank χ =9.623,31.564, 20.771, respectively; P < 0.01).

CONCLUSIONS

LPR on day 1 and NLPR on days 3 and 7 after admission are reliable predictors of prognosis in patients with severe extensive burns. The combination of the burn prognostic score index, LPR on day 1, and NLPR on days 3 and 7 was superior to the burn indexes alone in predicting a patient's prognosis.

摘要

目的

探讨各种全血细胞（CBC）衍生炎症指标对大面积烧伤患者住院死亡率的预测价值。

方法

计算了 135 例大面积烧伤患者入院后第 1、3、7 天的全身炎症指标，包括淋巴细胞-血小板比率（LPR）、中性粒细胞-淋巴细胞比率（NLR）、中性粒细胞-单核细胞比率（NMR）、单核细胞-淋巴细胞比率（MLR）、中性粒细胞-淋巴细胞-血小板比率（NLPR）、系统炎症指数（SII）和系统炎症反应指数（SIRI）。

结果

我们纳入了 135 例大面积烧伤患者，其中 97 例存活，38 例死亡。调整混杂因素后，仅入院第 1 天的 LPR、第 3、7 天的 NLPR 与生存显著相关（OR=1.237、1.097、1.104；95%CI：1.055-1.451、1.002-1.202、1.005-1.212）。多变量逻辑回归分析的最优截断值为入院第 1 天的 LPR 为 6.37，第 3 天的 NLPR 为 8.06，曲线下面积（AUC）分别为 0.695 和 0.794。第 7 天的 NLPR 的 AUC 值最高，为 0.814，最佳截断值为 3.84。入院第 1 天的 LPR、第 3、7 天的 NLPR 与烧伤预后评分指数联合预测患者预后的效果优于单独使用烧伤指数，三者联合 PBI 预测预后的效果最高（AUC=0.994）。Kaplan-Meier 生存分析显示，入院第 1 天 LPR 较高和第 3、7 天 NLPR 较高的患者预后较差（log-rank χ 2 值分别为 9.623、31.564、20.771，P 值均<0.01）。