摘要
目的 探讨控制营养状态(CONUT)评分、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)对感染性心内膜炎(IE)患者临床结局的预测价值.方法 回顾性分析2012年7月至2022年12月就诊于广西医科大学第一附属医院的205例IE患者的临床资料.采用多因素logistic回归分析确定IE患者临床结局的危险因素,受试者工作特征曲线(ROC)检验CONUT评分、NLR、LMR的预测能力.结果 根据患者的出院状态,78例(38%)的患者被评估为预后不良.LMR在预后不良组中显著降低(P<0.05).单因素分析显示,感染性休克、心房颤动、脑出血、葡萄球菌属感染以及较高水平的平均血小板体积、B型利钠肽原、NLR、CONUT评分与IE不良临床结局相关(P<0.05).多因素logistic回归分析显示,CONUT评分、心房颤动、B型利钠肽原是IE患者临床结局的独立预测因素(P<0.05).在ROC曲线分析中,入院时的CONUT评分联合NLR、CONUT评分、NLR、LMR预测IE患者不良临床结局的最佳临界值分别为0.318、4.5、5.715、1.982,其曲线下面积(AUC)分别为0.699、0.684、0.661、0.591,敏感度分别为0.718、0.654、0.679、0.622,特异度分别为0.614、0.638、0.685、0.590.结论 相较于NLR和LMR,CONUT评分是预测IE患者临床结局的一个较敏感指标,CONUT评分联合NLR可提高预测效能,为IE患者的危险分层和管理提供有价值的信息.
Abstract
Objective To explore the predictive value of controlling nutritional status(CONUT)score,neutrophil-to-lymphocyte ratio(NLR)and lymphocyte-to-monocyte ratio(LMR)for clinical outcomes in patients with infective endocarditis.Methods Retrospective analysis was made on the clinical data of 205 patients with infective endocarditis who were hospitalized in First Affiliated Hospital,Guangxi Medical University from July 2012 to December 2022.Multivariate logistic regression analysis was used to determine the risk factors for adverse clinical outcomes in patients with infective endocarditis.The predictive ability of CONUT score,NLR and LMR was tested by the receiver operating characteristic curve(ROC).Results According to the patient's discharge status,78 patients(38%)were assessed as having a poor prognosis.LMR significantly decreased in the group with poor prognosis(P<0.05).Univariate analysis showed that septic shock,atrial fibrillation,intracerebral hemorrhage,staphylococcus infection,and high levels of mean platelet volume,pro-brain natriuretic peptide,NLR,CONUT scores were associated with adverse clinical outcomes of infective endocarditis(P<0.05).Multivariate logistic regression analysis showed that CONUT score,atrial fibrillation and brain natriuretic peptide precursor were the independent predictors of clinical outcomes in patients with infective endocarditis(P<0.05).In the ROC curve analysis,the optimal critical values of CONUT score combined with NLR,CONUT score,NLR and LMR at admission for predicting adverse clinical outcomes in patients with infective endocarditis were 0.318,4.5,5.715 and 1.982,respectively.The area under the curve(AUC)was 0.699,0.684,0.661 and 0.591,respectively.The sensitivity was 0.718,0.654,0.679 and 0.622,respectively,and the specificity was 0.614,0.638,0.685 and 0.590,respectively.Conclusion Compared with NLR and LMR,CONUT score is a more sensitive index to predict the clinical outcome in patients with infective endocarditis,and the combination of CONUT score and NLR can improve the predictive efficiency,providing valuable information for risk stratification and management in patients with infective endocarditis.
基金项目
广西壮族自治区医疗卫生适宜技术开发与推广应用项目(S2021095)
NETL
NSTL
维普
万方数据