Lai Shaoqin, Li Xiaojun, Cai Donghao, Mei Chuangchuang, Liang Zhihui
Clinical Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China.
Administration Department of Nosocomial Infection, Guangdong Provincial Second Hospital of Traditional Chinese Medicine (Guangdong Provincial Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China.
BMC Geriatr. 2025 Apr 9;25(1):234. doi: 10.1186/s12877-025-05884-y.
Acinetobacter baumannii (A. baumannii) is one of the main pathogens that causesbloodstream infection (BSI) in elderly patients, with high morbidity and mortality rates once infected; new inflammatory indicators, such as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio(PLR), have been proposed in recent years, and the prognostic effects of these new inflammatory indicators have not yet been adequately investigated in A.baumannii BSI in elderly patients. Therefore, we verified the effects of these inflammatory indicators on A.baumannii BSIprognosis in elderly patients by constructing a nomogram model.
The clinical data of 126 elderly patients with A. baumannii BSIwere retrospectively analyzed, and they were divided into a survival group (87 patients) and a death group (39 patients) according to survival status 28 days after infection. Variables were screened by univariate Cox regression analysis and LASSO regression, respectively, and different prognostic models were constructed, and the final models were screened by cross-validation and other means, and the performance of the final models, such as differentiation, was evaluated. Finally, 47 exceptions of data were used to validate the prognostic model of A.baumanniiBSI in elderly patients.
Out of 126 patients, 39 died, for a mortality rate of 31.0%. A high neutrophil-plateletratio(NPR)(hazard ratio [HR] of 35.948,95% confidence interval [CI], 6.890-187.548) and a high C-reactive protein (CRP)-to-lymphocyte ratio (CLR) (HR,1.004;95% CI, 1.002-1.006) are independent risk factors for death in elderly patients with A. baumannii BSI. The model constructed by LASSO regression screening variables avoided the overfitting situation of the model and performed better overall and was considered as the final model.In the final model, the nomogram model predicted the highest discriminatory 7-day prognosis of A. baumanniiBSI in elderly patients, with an area under the working curve (AUC) of 0.821 for subjects, 0.777 and 0.783 for 14 and 28 days, respectively, and a standardized model with good agreement; The clinical decision curve revealed that the model provided good net benefit, ranging from 20 to 100%.
The NPR and CLR are closely associated with the prognosis of A. baumanniiBSI in elderly patients, and in clinical practice, a focus should be placed on these new indicators of inflammation, especially the NPR and CLR, to help physicians better assess the prognosis of A. baumanniiBSI in elderly patients and to develop a more effective therapeutic regimen to improve the survival rate of patients.
鲍曼不动杆菌是老年患者血流感染（BSI）的主要病原体之一，一旦感染，发病率和死亡率都很高；近年来提出了新的炎症指标，如中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR），而这些新炎症指标对老年患者鲍曼不动杆菌BSI的预后影响尚未得到充分研究。因此，我们通过构建列线图模型验证了这些炎症指标对老年患者鲍曼不动杆菌BSI预后的影响。
回顾性分析126例老年鲍曼不动杆菌BSI患者的临床资料，根据感染后28天的生存状态将其分为生存组（87例）和死亡组（39例）。分别通过单因素Cox回归分析和LASSO回归筛选变量，构建不同的预后模型，并通过交叉验证等方法筛选最终模型，评估最终模型的区分度等性能。最后，用47例数据验证老年患者鲍曼不动杆菌BSI的预后模型。
126例患者中，39例死亡，死亡率为31.0%。高中性粒细胞与血小板比值（NPR）（风险比[HR]为35.948，95%置信区间[CI]为6.890 - 187.548）和高C反应蛋白（CRP）与淋巴细胞比值（CLR）（HR为1.004；95%CI为1.002 - 1.006）是老年鲍曼不动杆菌BSI患者死亡的独立危险因素。通过LASSO回归筛选变量构建的模型避免了模型过拟合情况，整体表现更好，被视为最终模型。在最终模型中，列线图模型预测老年患者鲍曼不动杆菌BSI 7天预后的区分度最高，受试者工作曲线下面积（AUC）为0.821，14天和28天分别为0.777和0.783，且标准化模型一致性良好；临床决策曲线显示该模型在20%至100%的范围内提供了良好的净效益。
NPR和CLR与老年患者鲍曼不动杆菌BSI的预后密切相关，在临床实践中，应关注这些新的炎症指标，尤其是NPR和CLR，以帮助医生更好地评估老年患者鲍曼不动杆菌BSI的预后，并制定更有效的治疗方案，提高患者生存率。
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