qSOFA评分联合中性粒细胞CD64指数对恶性血液病患者血流感染的早期诊断价值

目的探讨快速序贯器官衰竭评估(qSOFA)评分联合中性粒细胞CD64指数(简称CD64指数)对恶性血液病患者血流感染的早期诊断价值。方法选择该院2019年6月至2020年6月收治的45例恶性血液病血流感染患者为研究对象(感染组),另选择同期恶性血液病无感染患者45例(非感染组)作为对照。测定CD64指数及肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、降钙素原(PCT)水平,评估患者的qSOFA评分。分析qSOFA评分、CD64指数与TNF-α、IL-6的相关性。采用受试者工作特征(ROC)曲线分析各指标的诊断价值;采用Logistic回归分析血流感染发生的危险因素。结果感染组患者qSOFA评分、CD64指数、TNF-α、IL-6水平明显高于非感染组(P<0.05),感染组中死亡患者qSOFA评分、CD64指数、TNF-α、IL-6水平明显高于非死亡患者(P<0.05);血流感染患者qSOFA评分、CD64指数与TNF-α、IL-6呈正相关(P<0.05)。qSOFA评分诊断恶性血液病患者血流感染的曲线下面积为0.637(95%CI:0.582~0.755),CD64指数诊断恶性血液病患者血流感染的曲线下面积为0.705(95%CI:0.695~0.813);qSOFA评分联合CD64指数诊断恶性血液病患者血流感染的曲线下面积为0.878(95%CI:0.831~0.926)。qSOFA评分、CD64指数、TNF-α、IL-6是恶性血液病患者发生血流感染的危险因素(P<0.05)。结论qSOFA评分、CD64指数联合应用对恶性血液病患者血流感染的早期诊断具有一定价值。

Value of qSOFA score combined with neutrophil CD64 index in early diagnosis of bloodstream infection in patients with hematological malignancies

Objective To explore the value of quick sequential organ failure assessment(qSOFA)score combined with neutrophil CD64 index(CD64 index)in early diagnosis of bloodstream infection in the patients with hematological malignancies.Methods Forty-five patients with hematological malignancies bloodstream infection in this hospital from June 2019 to June 2020 were selected as the research subjects(infection group),and 45 patients with hematological malignancies non-infection(non-infection group)in the same period were selected as the controls.The CD64 index,tumor necrosis factor(TNF)-α,interleukin(IL)-6 and procalcitonin(PCT)levels were detected.The qSOFA score was evaluated.The correlation between qSOFA score and CD64 index with TNF-αand IL-6 was analyzed.The diagnostic value of each index was analyzed by adopting the receiver operating characteristic(ROC)curve,and the risk factors of bloodstream infection occurrence were analyzed by adopting the Logistic regression.Results The qSOFA score,CD64 index,TNF-αand IL-6 levels in the infection group were significantly higher than those in the non-infection group(P<0.05).The qSOFA score,CD64 index,TNF-αand IL-6 levels in the death patients of the infection group were significantly higher than those in the non-death patients(P<0.05).In the patients with bloodstream infection,the qSOFA score and CD64 index were positively correlated with TNF-αand IL-6(P<0.05).The area under the curve(AUC)of qSOFA score for diagnosing bloodstream infection in the patients with hematological diseases was 0.637(95%CI:0.582-0.755),which of the CD64 index was 0.705(95%CI:0.695-0.813)and AUC of qSOFA score combined with CD64 index was 0.878(95%CI:0.831-0.926).The qSOFA score,CD64 index,TNF-αand IL-6 were the risk factors for the bloodstream infection occurrence in the patients with hematological diseases(P<0.05).Conclusion The combined application of qSOFA score and CD64 index has a certain value in the early diagnosis of bloodstream infection in the patients with hematological malignancies.