Singhal Akash, Dubey Shruti, Khan Shehtaj, Tiwari Reshma, Das Saurabh, Ahmad Reyaz
Critical Care Medicine, Max Super Speciality Hospital, Lucknow, Lucknow, IND.
Emergency Medicine, LN Medical College and Research Center, Bhopal, IND.
Cureus. 2024 Jun 14;16(6):e62360. doi: 10.7759/cureus.62360. eCollection 2024 Jun.
Biomarkers like white blood cells, C-reactive protein, procalcitonin, and interleukin-1 are used in patients with sepsis for early diagnosis, differentiating various infections, making decisions to start antibiotics and evaluate their response, and to prognosticate morbidity and mortality. Despite the availability of these biomarkers, the prognosis of patients with sepsis in the ICU remains poor. Hence, this study was carried out to test the efficacy of procalcitonin and neutrophil-to-lymphocyte ratio (NLR) to prognosticate mortality and morbidity in terms of incidence of organ dysfunction and length of ICU stay in sepsis patients.
In this prospective observational study, we measured NLR and procalcitonin at days one, three, and seven of sepsis patients and divided them into four groups: low NLR and high procalcitonin (LNHP), high NLR and high procalcitonin (HNHP), high NLR and low procalcitonin (HNLP), and low NLR and low procalcitonin (LNLP). Mortality at 28 days was noted as the primary outcome.
Out of 85 patients included in the study, five were lost to follow-up. Although no statistically significant difference was found in the primary outcome between all four groups, regression analysis showed that rising NLR and procalcitonin values were associated with a significant increase in mortality.
Serial values of NLR and procalcitonin are more important in predicting severity in comparison to a single value at presentation and can be used as a prognostic marker in sepsis patients.
白细胞、C反应蛋白、降钙素原和白细胞介素-1等生物标志物用于脓毒症患者的早期诊断、区分各种感染、决定是否开始使用抗生素并评估其反应，以及预测发病率和死亡率。尽管有这些生物标志物，但重症监护病房（ICU）中脓毒症患者的预后仍然很差。因此，本研究旨在测试降钙素原和中性粒细胞与淋巴细胞比值（NLR）在预测脓毒症患者器官功能障碍发生率和ICU住院时间方面的死亡率和发病率的疗效。
在这项前瞻性观察研究中，我们在脓毒症患者的第1天、第3天和第7天测量了NLR和降钙素原，并将他们分为四组：低NLR和高降钙素原（LNHP）、高NLR和高降钙素原（HNHP）、高NLR和低降钙素原（HNLP）以及低NLR和低降钙素原（LNLP）。将28天的死亡率作为主要结局进行记录。
在纳入研究的85例患者中，有5例失访。虽然四组之间在主要结局方面未发现统计学上的显著差异，但回归分析表明，NLR和降钙素原值的升高与死亡率的显著增加相关。
与初次就诊时的单一值相比，NLR和降钙素原的系列值在预测严重程度方面更为重要，并且可作为脓毒症患者的预后标志物。
