St. Luke's University Health Network, Bethlehem, Pennsylvania.
Regional One Health, Memphis, Tennessee.
West J Emerg Med. 2024 Sep;25(5):690-696. doi: 10.5811/westjem.18466.
Determining which patients who meet systemic inflammatory response syndrome (SIRS) criteria have bacterial sepsis is a difficult challenge for emergency physicians. We sought to determine whether the neutrophil-to-lymphocyte ratio (NLR) could be used to exclude bacterial sepsis in adult patients who meet ≥2 SIRS criteria and are being evaluated for sepsis.
Consenting adult patients meeting ≥2 SIRS criteria and undergoing evaluation for sepsis were enrolled. We recorded patient age, gender, vital signs, and laboratory results. We then later reviewed health records for culture results, end organ dysfunction, survival to discharge, and final diagnoses. Patients were classified as having sepsis if they met ≥2 SIRS criteria and were ultimately diagnosed with a bacterial source. We analyzed data using descriptive statistics and sensitivity and specificity analyses. A receiver operating characteristic curve (ROC) was created to determine test characteristics.
A total of 231 patients had complete datasets. Patients' median age was 69 (interquartile range [IQR] 54-81), and 49.6% were male. There were 154 patients (66.7%) ultimately diagnosed with sepsis with an identified bacterial source, while 77 patients with ≥2 SIRS criteria had non-infectious reasons for their presentations (33.3%). Septic patients had a median NLR 12.36 (IQR [interquartile range] 7.29-21.69), compared to those without sepsis (median NLR 5.62, IQR 3.89-9.11, < 0.001). The NLR value of 3 applied as a cutoff for sepsis had a sensitivity of 96.8 (95% confidence interval [CI] 92.2-98.8), and a specificity of 18.2 (95% CI 10.6-29.0). The ROC for NLR had an area under the curve of 0.74.
The neutrophil-to-lymphocyte ratio is a sensitive tool to help determine which patients with abnormal SIRS screens have bacterial sepsis.
对于急诊医师来说，确定符合全身炎症反应综合征（SIRS）标准的患者中哪些患有细菌性败血症是一项艰巨的挑战。我们试图确定中性粒细胞与淋巴细胞比值（NLR）是否可用于排除符合≥2 SIRS 标准且正在接受败血症评估的成年患者中的细菌性败血症。
纳入符合≥2 SIRS 标准且正在接受败血症评估的成年患者。我们记录了患者的年龄、性别、生命体征和实验室结果。然后，我们回顾了病历，以了解培养结果、终末器官功能障碍、生存至出院和最终诊断。如果患者符合≥2 SIRS 标准且最终被诊断为细菌来源，则被归类为败血症。我们使用描述性统计和敏感性及特异性分析来分析数据。创建了受试者工作特征曲线（ROC）来确定测试特征。
共有 231 例患者具有完整的数据集。患者的中位年龄为 69 岁（四分位距 [IQR] 54-81），49.6%为男性。有 154 例患者（66.7%）最终被诊断为败血症，其细菌来源可识别，而 77 例符合≥2 SIRS 标准的患者因非感染性原因出现症状（33.3%）。败血症患者的 NLR 中位数为 12.36（IQR [四分位距] 7.29-21.69），而无败血症患者的 NLR 中位数为 5.62（IQR 3.89-9.11）， < 0.001）。NLR 值为 3 时，作为败血症的截断值，其敏感性为 96.8%（95%置信区间 [CI] 92.2-98.8），特异性为 18.2%（95% CI 10.6-29.0）。NLR 的 ROC 曲线下面积为 0.74。
中性粒细胞与淋巴细胞比值是一种敏感的工具，可帮助确定异常 SIRS 筛查患者中哪些患有细菌性败血症。
