中性粒细胞与淋巴细胞比值联合红细胞分布宽度在急诊老年脓毒症病人中的应用价值

目的 探讨中性粒细胞与淋巴细胞比值(NLR)结合红细胞分布宽度(RDW)对急诊老年脓毒症病人疾病严重程度和预后的评估意义。方法 收集2019年1月到2022年2月在首都医科大学宣武医院急诊科就诊及住院治疗的老年脓毒症病人169例。病人入急诊后给予生化全项、血气分析、全血细胞计数、降钙素原(PCT)、胸部计算机体层摄影(CT)、病原学检查等。依据以上检查结果进行急性生理与慢性健康状况评估(APACHEⅡ)。根据病人入急诊时合并脓毒性休克情况分为脓毒症组114例和脓毒性休克组55例。随访28 d，依据病人死亡情况分成生存组125例和死亡组44例。分别比较脓毒性休克组和脓毒症组、生存组和死亡组病人NLR、白细胞计数(WBC)、PCT、RDW和APACHEⅡ评分的区别，进行NLR、RDW与PCT及APACHEⅡ评分的相关性分析；分析RDW、NLR及2个指标相互结合评估老年脓毒症病人死亡风险的受试者工作特征曲线下面积(AUC)和PCT曲线下面积的区别。结果 脓毒症休克组病人PCT、NLR、RDW和APACHEⅡ评分分别为(1.86±1.04)μg/L、9.63±3.92、(14.95±3.49)...

Application value of neutrophil to lymphocyte ratio combined with red blood cell distribution width in emergency elderly sepsis patients

Objective To study the value of neutrophil to lymphocyte rate (NLR) combined with red blood cell distribution width(RDW) in evaluating the condition and prognosis of elderly sepsis patients in emergency.Methods One hundred and sixty-nine elder? ly sepsis patients in the Department of Emergency, Xuanwu Hospital of Capital Medical University from January 2019 to February2022 were accumulated. After entering the emergency department, biochemical examination, blood gas analysis, blood routine examina?tion, procalcitonin (PCT), chest computer tomography (CT), etiological examination and other examinations were given, the acute physi?ology and chronic health evaluation (APACHE Ⅱ) scores were scored according to the inspection results. According to the patient''sconcurrent septic shock at the time of admission to the emergency department, there were 114 cases of sepsis and 55 cases of septicshock. After 28 days of follow-up, the patients were separated into a survival group of 125 cases and a death group of 44 cases. The dif?ferences of PCT, white blood cell count (WBC), NLR, APACHE Ⅱ scores and RDW were compared between sepsis group and septicshock group, the differences of those were also compared between the death group and the survival group. The correlation betweenNLR, RDW and APACHE Ⅱ scores, PCT were analyzed. The difference of area under receiver operating characteristic curve (AUC) ofRDW, NLR, their combination and PCT in predicting death were compared in elderly sepsis patients.Results The PCT, NLR, RDW,and APACHE Ⅱ scores of patients in the septic shock group were respectively (1.86±1.04) μg/L, 9.63±3.92, (14.95±3.49)% and(16.75±3.53) points, these indicators were significantly higher than the sepsis group [PCT (1.38±1.06) μg/L, NLR (7.87±3.94), RDW(12.74±3.83)% and APACHE Ⅱ scores (14.61±2.87) points ] (P<0.01). The difference of WBC was not obvious between the survival group and the death group (P=0.361). The APACHE Ⅱ score, NLR, PCT and RDW of the death group were (18.52±2.41) points, 10.64±3.74, (2.55 ±1.14) μg/L and (15.98±3.69)% respectively, these indicators were all higher than the survival group [APACHE Ⅱ score(14.17±2.71) points, NLR (7.67±3.82), PCT (1.19±0.81) μg/L and RDW (12.57±3.43)%] (P<0.01). The RDW and NLR were correlated with APACHE Ⅱ scores and PCT (all P<0.01). The AUC 95%CI of PCT in predicting death was 0.86 (0.80, 0.92), the AUC of APACHEⅡ scores was 0.88 (0.83, 0.93), the AUC of RDW was 0.75 (0.66, 0.83), and the AUC of NLR was 0.73 (0.64, 0.81). The AUC of RDWand NLR was smaller than that of PCT (P=0.048, 0.024), but the AUC of RDW combined with NLR was 0.80, which had no significant difference compared with PCT (P=0.363).Conclusion Both NLR and RDW indicators have good application value in the evaluation ofthe condition and prognosis of elderly sepsis patients, the combined evaluation value of the two indicators is similar to that of PCT.