目的:探讨外周血炎症指标中性粒细胞与淋巴细胞和血小板之间的比率(neutrophil/lymphocyte and platelet ratio,N/LP)、血小板和淋巴细胞的比率(platelet to lymphocyte ratio,PLR)、单核细胞和淋巴细胞的比率(monocytes and lymphocytes ratio,MLR)对脓毒症急性肾损伤的临床诊断及预测的价值.方法:回顾性分析收治的300例脓毒症患者的临床资料,按照改善全球肾脏病预后指南(KDIGO)定义急性肾损伤(acute kidney injury,AKI),将患者分为脓毒症急性肾损伤组(S-AKI组)和脓毒症非AKI组,比较两组间各指标差异,采用lo-gistic 回归模型分析筛选出发生AKI的独立危险因素,绘制受试者工作特征(receiver operator characteristic,ROC)曲线,并计算曲线下面积(area under the curve,AUC),评估外周血炎症指标对脓毒症肾损伤的临床预测价值.结果:①纳入脓毒症患者中S-AKI组133例,脓毒症非AKI组167例,S-AKI组发病率为44.33％,N/LP、PLR、MLR显著高于脓毒症非AKI组,差异有统计学意义(N/LP:Z=6.397,P＜0.001;PLR:Z=6.476,P＜0.001;MLR:Z=6.999,P＜0.001),并且S-AKI患者28 d内病死率(46.6％vs.26.3％)更高,合并更多的器官受损、需要更多的血管活性药物及血液透析维持,SOFA评分和APACHEⅡ评分更高(均P＜0.05).②多因素logistic 回归分析发现 N/LP、PLR、MLR 是 S-AKI 发生的独立危险因素(N/LP:OR=1.03,95％CI:1.005～1.055,P=0.019;PLR:OR=1.004,95％CI:1.002～1.007,P＜0.001;MLR:OR=2.344,95％CI:1.156～4.755,P=0.018);AUC 分别为 0.715(95％CI:0.676～0.774)、0.718(95％CI:0.661～0.775)、0.735(95％CI:0.679～0.791),均P＜0.001;截断值分别为8.7、99.81和0.615,三者联合预测时ROC的AUC为0.794(95％CI:0.743～0.844,P＜0.001).结论:N/LP、MLR 和 PLR 联合检测可评估 S-AKI 的发生.
Prognostic value of peripheral blood inflammatory index in sepsis associated with acute kidney injury
Objective:To study the value of the neutrophil/lymphocyte and platelet ratio(N/LP),platelet/lymphocyte ratio(PLR),monocyte and lymphocyte ratio(MLR)in clinical diagnosis and prediction of patients with acute renal impairment in sepsis.Methods:The clinical data of 300 patients with sepsis were retrospectively analyzed,according to the definition of acute kidney injury(AKI)in the Guidelines for Improving Global Renal Outcomes(KDIGO),the patients were classified into two groups:S-AKI and non-AKI.Differences in all the pa-rameters were compared between two groups.The logistic regression model was used to select independent risk factors of AKI,and a ROC curve was drawn and the AUC was calculated to assess the clinical value of peripheral inflammation in patients with septic renal injury.Results:① Among the patients with sepsis,133 cases were in-cluded in S-AKI group and 167 cases were included in non-AKI group.The incidence in S-AKI group was 44.33％,and difference between N/LP,PLR,MLR and non-AKI was statistically significant(N/LP:Z=6.397,P＜0.001;PLR:Z=6.476,P＜0.001;MLR:Z=6.999,P＜0.001),and S-AKI patients had higher 28-day mortality(46.6％vs.26.3％),more organ damage,more vasoactive drugs required,and hemodialysis mainte-nance,resulting in higher SOFA and APACHEⅡ scores(all P＜0.05).②Multivariate logistic regression analysis indicated that the risk factors of S-AKI were N/LP,PLR and MLR.OR of N/LP=1.03,95％CI:1.005-1.055,P=0.019;PLR:OR=1.004,95％CI:1.002-1.007,P＜0.001;MLR:OR=2.344,95％CI:1.156-4.755,P=0.018,The AUC values were 0.715(95％CI:0.676-0.774),0.718(95％CI:0.661-0.775),0.735(95％CI:0.679-0.791)(P＜0.001),and the cutoff values were 8.7,99.81 and 0.615,respectively.The area under ROC curve for the three joint prediction was 0.794(95％CI:0.743-0.844,P＜0.001).Conclusion:The combined detection of N/LP,MLR and PLR can evaluate the occurrence of S-AKI.
NETL
NSTL
万方数据
