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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2024, Vol. 17 ›› Issue (02) : 118 -123. doi: 10.3877/cma.j.issn.1674-6880.2024.02.005

论著

血小板与淋巴细胞比值、降钙素原和白细胞介素6联合检测对脓毒症患者预后价值的研究
贾亚娟1, 蒙钰铭2, 高志伟1, 高素敏1, 张劲松3, 孙虹1,†()   
  1. 1. 223300　江苏淮安，南京医科大学附属淮安第一医院急诊科
    2. 530021　南宁，广西医科大学第一附属医院急诊科
    3. 210000　南京，南京医科大学第一附属医院急诊科
  • 收稿日期:2023-10-19 出版日期:2024-04-30
  • 通信作者: 孙虹

Predictive value of combined detection of platelet to lymphocyte ratio, procalcitonin and interleukin-6 in prognosis of patients with sepsis

Yajuan Jia1, Yuming Meng2, Zhiwei Gao1, Sumin Gao1, Jinsong Zhang3, Hong Sun1,†()   

  1. 1. Department of Emergency Medicine, the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223300, China
    2. Department of Emergency Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
    3. Department of Emergency Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210000, China
  • Received:2023-10-19 Published:2024-04-30
  • Corresponding author: Hong Sun
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贾亚娟, 蒙钰铭, 高志伟, 高素敏, 张劲松, 孙虹. 血小板与淋巴细胞比值、降钙素原和白细胞介素6联合检测对脓毒症患者预后价值的研究[J]. 中华危重症医学杂志(电子版), 2024, 17(02): 118-123.

Yajuan Jia, Yuming Meng, Zhiwei Gao, Sumin Gao, Jinsong Zhang, Hong Sun. Predictive value of combined detection of platelet to lymphocyte ratio, procalcitonin and interleukin-6 in prognosis of patients with sepsis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(02): 118-123.

目的

探讨血小板与淋巴细胞比值（PLR）、降钙素原（PCT）、白细胞介素6（IL-6）联合检测对急性脓毒症患者28 d预后的预测价值。

方法

回顾性分析2021年10月至2023年6月南京医科大学附属淮安第一医院急诊科诊治的126例脓毒症患者的临床数据，根据入组患者28 d临床结局将其分为存活组（95例）和死亡组（31例）。比较两组患者在急诊科诊治的24 h内的一般资料、PLR、PCT、IL-6、血乳酸、序贯器官衰竭估计（SOFA）评分、急性病生理学和长期健康评价（APACHE）Ⅱ评分、血小板计数、淋巴细胞计数等。采用多因素logistic回归分析检测影响脓毒症患者28 d预后的危险因素。采用受试者工作特征（ROC）曲线分析PLR、PCT、IL-6单独检测及联合检测对脓毒症患者28 d预后的预测价值。

结果

死亡组患者PLR、PCT、IL-6、乳酸、SOFA评分、APACHEⅡ评分均高于存活组（P均< 0.05）。多因素logistic回归结果分析显示，PLR[比值比（OR）= 1.018，95%置信区间（CI）（1.009，1.028），P < 0.001]、PCT[OR = 1.040，95%CI（1.018，1.064），P < 0.001]、IL-6[OR = 1.065，95%CI（1.004，1.109），P = 0.045]、APACHEⅡ评分[OR = 1.194，95%CI（1.075，1.325），P < 0.001]均为脓毒症患者不良结局的独立危险因素。ROC曲线结果分析显示，PLR、PCT、IL-6三者联合对脓毒症患者28 d预后的预测价值均优于单独检测PLR、PCT和IL-6 （Z = 2.059、2.144、2.001，P = 0.039、0.032、0.045）。

结论

PLR、PCT、IL-6水平在脓毒症死亡组患者中明显升高，是预测脓毒症患者28 d预后的独立危险因子，在其预后评估中有重要价值，值得被进一步关注。

关键词: 脓毒症, 血小板与淋巴细胞比值, 降钙素原, 白细胞介素6, 28 d预后
Objective

To explore the predictive value of combined detection of platelet to lymphocyte ratio (PLR), procalcitonin (PCT) and interleukin-6 (IL-6) in 28-day prognosis of patients with sepsis.

Methods

The clinical data of 126 patients with sepsis admitted to the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from October 2021 to June 2023 were retrospectively analyzed. According to the clinical outcome of 28 days, they were divided into a survival group (95 patients) and a death group (31 patients). The indexes detected within 24 hours of treatment in the Department of Emergency Medicine were compared between the two groups, including the general information, PLR, PCT, IL-6, lactic acid, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE) II score, platelet count and lymphocyte count. Multivariate logistic regression analysis was used to detect the risk factors affecting the death of sepsis patients. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of PLR, PCT and IL-6 in the prognosis of sepsis patients.

Results

The PLR, PCT, IL-6, lactic acid, SOFA score and APACHEII score of the death group were higher than those of the survival group (all P < 0.05). Multivariate logistic regression analysis showed that the PLR [odds ratio (OR) = 1.018, 95% confidence interval (CI) (1.009, 1.028), P < 0.001], PCT [OR = 1.040, 95%CI (1.018, 1.064), P < 0.001], IL-6 [OR = 1.065, 95%CI (1.004, 1.109), P = 0.045] and APACHEII score [OR = 1.194, 95%CI (1.075, 1.325), P < 0.001] were independent risk factors for adverse outcomes in patients with sepsis. The ROC curve analysis showed that the combined use of PLR, PCT and IL-6 had better predictive value for the 28-day prognosis of sepsis patients than the use of PLR, PCT and IL-6 alone (Z = 2.059, 2.144, 2.001; P = 0.039, 0.032, 0.045).

Conclusion

The levels of PLR, PCT and IL-6 significantly increased in patients who died of sepsis, and they are independent risk factors for predicting the 28-day prognosis of sepsis patients, which are of great value in the prognosis evaluation and deserve further attention.

Key words: Sepsis, Platelet to lymphocyte ratio, Procalcitonin, Interleukin-6, 28-day prognosis
表1 两组脓毒症患者一般资料比较[M（P25，P75）]
组别 例数 年龄（岁， ± s） 性别（例，男/女） 感染部位（例） PLR PCT（μg/L）
肝胆 腹腔 泌尿 肺部 其他
存活组 95 66 ± 14 50/45 15 7 45 14 14 100（68，131） 20.6（5.2，47.2）
死亡组 31 66 ± 15 18/13 5 2 4 14 6 165（108，2 262） 65.3（28.1，81.7）
t/Z/χ2值   0.055 0.278 0.002 0.030 11.682 12.517 0.373 4.441 3.945
P值   0.956 0.598 0.964 0.863 <0.001 <0.001 0.541 <0.001 <0.001
组别 例数 IL-6（ng/L） 乳酸（mmol/L） SOFA评分（分） APACHEⅡ评分（分， ± s） 血小板计数（× 109/L） 淋巴细胞计数（× 109/L） CRP（mg/L） 肌酐（μmol/L）
存活组 95 172（75，286） 2.7（1.7，3.5） 8（4，10） 14 ± 6 102（68，158） 0.8（0.4，1.1） 158（102，197） 144（88，228）
死亡组 31 313（170，1 316） 3.8（2.0，5.7） 10（7，13） 21 ± 7 113（56，179） 0.6（0.4，1.2） 140（87，193） 116（89，189）
t/Z/χ2值   3.277 2.241 2.760 3.122 0.207 0.620 0.827 0.651
P值   0.001 0.025 0.006 <0.001 0.836 0.535 0.408 0.515
表2 影响脓毒症患者28 d预后的多因素logistic回归分析
变量 回归系数 标准误 Wald值 P值 OR值 95%CI
PLR 0.018 0.005 15.028 <0.001 1.018 1.009 ~ 1.028
PCT（μg/L） 0.040 0.011 12.395 <0.001 1.040 1.018 ~ 1.064
IL-6（ng/L） 0.063 0.031 5.034 0.045 1.065 1.004 ~ 1.109
乳酸（mmol/L） 0.123 0.068 3.278 0.070 1.131 0.990 ~ 1.239
SOFA评分（分） 0.205 0.118 3.010 0.083 1.227 0.974 ~ 1.547
APACHEⅡ评分（分） 0.177 0.053 10.992 <0.001 1.194 1.075 ~ 1.325
图1 PLR、PCT、IL-6对脓毒症患者28 d死亡风险评估的ROC曲线注：PLR.血小板与淋巴细胞比值；PCT.降钙素原；IL-6.白细胞介素6；ROC.受试者工作特征
表3 PLR、PCT、IL-6联合检测对脓毒症患者28 d死亡风险的预测价值
变量 AUC 95%CI P值 截断值 敏感度 特异度
PLR 0.766 0.668 ~ 0.864 <0.001 135.0 0.677 0.768
PCT（μg/L） 0.737 0.631 ~ 0.842 <0.001 49.5 0.667 0.779
IL-6（ng/L） 0.696 0.598 ~ 0.794 0.001 192.1 0.710 0.653
三者联合 0.828 0.742 ~ 0.913 <0.001 - 0.710 0.821
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