Wang Zhongjie, Li Renhua, Yuan Zhe, Zhang Zuli, Qian Keli
Department of Infection Control, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Cell Infect Microbiol. 2024 Nov 28;14:1461325. doi: 10.3389/fcimb.2024.1461325. eCollection 2024.
Systemic inflammatory indicators such as neutrophil-to-lymphocyte ratio (NLR) can effectively predict the prognosis of various inflammatory diseases. However, its prognostic effect on patients with carbapenem-resistant (CRKP) infection is little known. The objective of this study was to investigate the risk factors for mortality associated with CRKP infection and the clinical value of NLR in predicting prognosis in these patients.
A total of 190 inpatients with CRKP infection from 1 January 2023 to 31 December 2023 were enrolled in this study, namely, 73 fatal cases and 117 survival cases in hospital. The medical data and examination results of these patients were collected. A logistic regression analysis was performed to assess the association between the NLR on the day of CRKP infection onset and all-cause mortality in hospital.
The overall mortality rate of patients with CRKP infection was 38.42% (73/190). Of the 190 patients, 91 were co-infected with carbapenem-resistant /carbapenem-resistant (CRAB/CRPA). Multifactor regression analysis confirmed that carbapenem exposure in the past 14 days, central line insertion, and chronic Foley catheter requirement were independent risk factors for carbapenem-resistant bacteria co-infection. The multivariate analysis shows that admission to an ICU, co-infection with CRAB/CRPA, and higher NLR were independent risk factors for the mortality in hospital, while appropriate treatment within 3 days was an independent protective factor. The area under the curve (AUC) of the NLR was 0.696, and the cutoff value of the NLR was 10.73.
The NLR on the day of CRKP infection onset, admission to an ICU, and co-infection with CRAB/CRPA were identified as independent risk factors for all-cause mortality of patients with CRKP infection, while appropriate treatment within 3 days was recognized as an independent protective factor. The NLR serves as a conveniently accessible and independent prognostic biomarker for patients with CRKP infection.
中性粒细胞与淋巴细胞比值（NLR）等全身炎症指标可有效预测各种炎症性疾病的预后。然而，其对耐碳青霉烯类肺炎克雷伯菌（CRKP）感染患者的预后影响鲜为人知。本研究的目的是调查与CRKP感染相关的死亡风险因素以及NLR在预测这些患者预后中的临床价值。
本研究纳入了2023年1月1日至2023年12月31日期间共190例CRKP感染住院患者，即73例死亡病例和117例住院存活病例。收集了这些患者的医疗数据和检查结果。进行逻辑回归分析以评估CRKP感染发病当天的NLR与住院全因死亡率之间的关联。
CRKP感染患者的总体死亡率为38.42%（73/190）。在190例患者中，91例合并耐碳青霉烯类鲍曼不动杆菌/耐碳青霉烯类铜绿假单胞菌（CRAB/CRPA）感染。多因素回归分析证实，过去14天内使用碳青霉烯类药物、中心静脉置管和长期留置导尿管是耐碳青霉烯类细菌合并感染的独立危险因素。多变量分析显示，入住重症监护病房（ICU）、合并CRAB/CRPA感染和较高的NLR是住院死亡的独立危险因素，而3天内进行适当治疗是独立保护因素。NLR的曲线下面积（AUC）为0.696，NLR的截断值为10.73。
CRKP感染发病当天的NLR、入住ICU和合并CRAB/CRPA感染被确定为CRKP感染患者全因死亡的独立危险因素，而3天内进行适当治疗被认为是独立保护因素。NLR是CRKP感染患者方便获取的独立预后生物标志物。
