Huang Xiaoling, Huang Lihua, Zhao Shicai, Yuan Lingyan, Wang Xing, Tang Guanghua, Yuan Kaifen, Xiao Min
Department of Respiratory, Sichuan Provincial People's Hospital East Sichuan Hospital & Dazhou First People's Hospital, Dazhou, Sichuan, People's Republic of China.
Department of Infection Disease, The First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China.
Int J Gen Med. 2025 Mar 5;18:1295-1309. doi: 10.2147/IJGM.S501744. eCollection 2025.
To investigate the prognostic value of hematological indices derived from routine blood tests in assessing 30-day mortality risk among elderly patients with bacterial pneumonia at the time of admission.
This study was conducted in the Second Affiliated Hospital of Kunming Medical University. A total of 292 elderly patients with bacterial pneumonia were enrolled. A total of 292 elderly patients diagnosed with bacterial pneumonia were classified into two groups: the survival group (n= 256) and the mortality group (n=36). Following a Propensity Score Matching at a 1:1 ratio, differences in clinical data between the two groups were analyzed using the chi-square test and Mann-Whitney -test. Furthermore, Spearman correlation analysis was employed to explore the relationships among the variables. The Receiver Operating Characteristic (ROC) curve was used to evaluate the predictive value of each index for 30-day mortality in elderly patients with bacterial pneumonia. Subsequently, pivotal risk indices were identified through multivariate logistic regression and Kaplan-Meier survival curves were constructed to illustrate the survival outcomes.
NLR, SII, SIRI and NMLR in the death group were significantly higher than those in the survival group (14.64 vs 5.47, 2621.05 vs 1308.01, 5.58 vs 2.36, 15.05 vs 5.75) (all P<0.05). And it was positively correlated with IL-6, PCT and hsCRP (all P<0.05). The ROC curve showed that the AUC of NLR, SII, SIRI and NMLR were 0.777,0.705,0.673 and 0.775 respectively. Multivariate Logistic regression analysis showed that NLR and PCT were the main risk indicators. When NLR≥15.46 (OR 18.44), SII≥2295.02 (OR 6.25), SIRI≥2.49 (OR 4.38) and NMLR≥15.72 (OR 17.00), the 30-day mortality of elderly patients with bacterial pneumonia was significantly increased.
In elderly patients with community-acquired bacterial pneumonia, increased NLR, SII, SIRI and NMLR can predict 30-day mortality to a certain extent, but further multicenter studies are needed to verify.
探讨常规血液检查所得血液学指标在评估老年细菌性肺炎患者入院时30天死亡风险中的预后价值。
本研究在昆明医科大学第二附属医院进行。共纳入292例老年细菌性肺炎患者。将292例确诊为细菌性肺炎的老年患者分为两组：存活组（n = 256）和死亡组（n = 36）。按1:1比例进行倾向得分匹配后，采用卡方检验和曼-惠特尼检验分析两组临床资料的差异。此外，采用Spearman相关性分析探讨各变量之间的关系。采用受试者工作特征（ROC）曲线评估各指标对老年细菌性肺炎患者30天死亡率的预测价值。随后，通过多因素逻辑回归确定关键风险指标，并构建Kaplan-Meier生存曲线以说明生存结果。
死亡组的中性粒细胞与淋巴细胞比值（NLR）、全身炎症反应指数（SII）、全身免疫炎症指数（SIRI）和中性粒细胞与单核细胞比值（NMLR）显著高于存活组（14.64对5.47、2621.05对1308.01、5.58对2.36、15.05对5.75）（均P<0.05）。且与白细胞介素-6（IL-6）、降钙素原（PCT）和超敏C反应蛋白（hsCRP）呈正相关（均P<0.05）。ROC曲线显示，NLR、SII、SIRI和NMLR的曲线下面积（AUC）分别为0.777、0.705、0.673和0.775。多因素逻辑回归分析显示，NLR和PCT是主要风险指标。当NLR≥15.46（比值比[OR]为18.44）、SII≥2295.02（OR为6.25）、SIRI≥2.49（OR为4.38）和NMLR≥15.72（OR为17.00）时，老年细菌性肺炎患者的30天死亡率显著增加。
在社区获得性细菌性肺炎老年患者中，NLR、SII、SIRI和NMLR升高在一定程度上可预测30天死亡率，但需要进一步的多中心研究进行验证。
