CD3+T淋巴细胞计数联合早期预警评分对重症肺炎患者28 d死亡风险的预测价值

Predictive value of CD3+T lymphocyte count combined with early warning score for 28-day mortality risk of severe pneumonia

摘要:

目的 分析CD3⁺T淋巴细胞计数联合早期预警评分（EWS）预测重症肺炎患者28 d死亡风险的价值。方法 选取2020年6月—2021年5月天津市中医药研究院附属医院收治的78例重症肺炎患者为研究对象。根据患者28 d后生存状况，将其分为死亡组与存活组，比较两组CD3⁺T淋巴细胞计数、EWS评分及其他临床指标，行一般多因素Logistic回归分析，筛查重症肺炎患者28 d死亡的影响因素，绘制受试者工作特征曲线（ROC），分析CD3⁺T淋巴细胞计数、EWS评分预测重症肺炎患者28 d死亡的价值。结果 死亡组入院时SOFA评分、APACHEⅡ评分、EWS评分高于存活组（P <0.05），死亡组ICU住院时间、机械通气时间长于存活组（P <0.05），死亡组入院时CD3⁺、CD4⁺及CD8⁺少于存活组（P <0.05）。Pearson相关性分析结果显示，死亡组患者入院时外周血CD3⁺与EWS评分呈负相关（r =-0.422，P =0.000），CD4⁺、CD8⁺、CD4⁺/CD8⁺与EWS评分无相关性（r =-0.113、-0.122和-0.171，P =0.684、0.682和0.661）。ROC曲线结果表明，入院时CD3⁺（敏感性为73.9%，特异性为81.1%）、EWS评分（敏感性为91.3%，特异性为54.7%）预测重症肺炎患者28 d死亡效能较好，且两者联合应用可有效提高各指标单独应用效能（敏感性为78.3%，特异性为77.4%）。一般多因素Logistic回归分析结果：入院时EWS评分［O^R=1.701（95% CI：1.347，2.147）］、入院时APACHEⅡ评分［O^R=1.578（95% CI：1.284，1.938）］、ICU住院时间［O^R=1.399（95% CI：1.095，1.788）］、机械通气时间［O^R=1.335（95% CI：1.155，1.543）］是重症肺炎患者28 d死亡的危险因素（P <0.05）；入院时外周血CD3⁺［O^R=0.679（95% CI：0.556，0.829）］是重症肺炎患者28 d死亡的保护因素（P <0.05）。结论 入院时EWS评分、外周血T淋巴细胞亚群中CD3⁺联合预测重症肺炎患者28 d死亡效能较好，可作为临床评估患者预后的新指标，且入院时EWS评分也是导致重症肺炎患者28 d死亡的危险因素，CD3⁺是其保护因素。

Abstract:

Objective To investigate the predictive value of CD3⁺T lymphocyte count combined with early warning score (EWS) for 28-day mortality risk of severe pneumonia.Methods Seventy-eight patients with severe pneumonia in our hospital from June 2020 to May 2021 were enrolled and divided into death group and survival group according to the 28-day survival status. The CD3⁺T lymphocyte count, EWS score and other clinical indicators were compared between the two groups. Multivariable Logistic regression analysis was performed to screen the factors affecting the 28-day mortality of patients with severe pneumonia. Thereafter, receiver operating characteristic (ROC) curve was used to analyze the values of CD3⁺T lymphocyte count and EWS score in predicting 28-day mortality in patients with severe pneumonia.Results The Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and EWS scores at admission were significantly higher in death group than in survival group (P < 0.05). The length of intensive care unit (ICU) stay and the duration of mechanical ventilation were significantly longer in death group than in survival group (P < 0.05). The levels of CD3⁺, CD4⁺ and CD8⁺T cells at admission in death group were significantly higher than those in survival group (P < 0.05). Pearson correlation analysis indicated that the level of peripheral blood CD3⁺T cells was negatively correlated with the EWS score at admission in the death group (r = -0.422, P = 0.000), while the levels of CD4⁺ and CD8⁺T cells and CD4⁺ / CD8⁺ ratio had no correlation with the EWS score (r =-0.113, -0.122, and -0.171, P =0.684, 0.682, and 0.661). The ROC curve analysis found that the level of CD3⁺T lymphocyte (sensitivity of 73.9% and specificity of 81.1%) and the EWS score (sensitivity of 91.3% and specificity of 54.7%) at admission exhibited great efficacy in predicting the 28-day mortality of patients with severe pneumonia, and the combined detection of the level of CD3⁺T lymphocyte and the EWS score at admission increased the predictive efficacy with the sensitivity and specificity being 78.3% and 77.4%, respectively. Multivariable Logistic regression analysis showed that the EWS score at admission [O^R = 1.701 (95% CI: 1.347, 2.147) ], the APACHE Ⅱ score at admission [O^R = 1.578 (95% CI: 1.284, 1.938) ], the length of ICU stay [O^R = 1.399 (95% CI: 1.095, 1.788) ] and the duration of mechanical ventilation [O^R = 1.335 (95% CI: 1.155, 1.543) ] were risk factors for the 28-day mortality of patients with severe pneumonia (P < 0.05), and that the peripheral blood CD3⁺T lymphocyte level at admission [O^R = 0.679 (95% CI: 0.556, 0.829) ] was a protective factor for the 28-day mortality of patients with severe pneumonia (P < 0.05).Conclusions The combined detection of the EWS score and the level of peripheral blood CD3⁺T lymphocytes at admission exhibits good efficacy in predicting the 28-day mortality of patients with severe pneumonia. Therefore, the two indicators can be used in evaluating the clinical prognosis. Moreover, the EWS score at admission is a risk factor while the peripheral blood CD3⁺T lymphocyte level is a protective factor for the 28-day mortality of patients with severe pneumonia.