嗜酸性粒细胞联合hs-CRP对输血后不良反应的预测价值

Predictive value of eosinophil count combined with hs-CRP levels in adverse reactions to blood transfusion

摘要:

目的 分析嗜酸性粒细胞（EOS）联合超敏C反应蛋白（hs-CRP）对输血后不良反应的预测价值。方法 回顾性分析2020年5月—2022年1月绵阳市中心医院收治的85例接受输血治疗的住院患者的临床资料。根据输血后是否出现不良反应分为对照组（没有出现输血后不良反应）与研究组（出现输血后不良反应），分别有44和41例。两组接受输血治疗，比较两组输血前后血清EOS、hs-CRP差值，比较两组的临床资料。采用多因素一般Logistic回归模型分析输血后发生不良反应的影响因素。制作受试者工作特征（ROC）曲线，以曲线下面积（AUC）分析输血前后血清EOS、hs-CRP差值对输血后不良反应的预测价值。结果 研究组输血次数> 2次、发血至输血时间≥ 30 min占比高于对照组（P <0.05）。两组患者性别、年龄、BMI、科室分布、基础疾病、吸烟史、饮酒史比较，差异均无统计学意义（P >0.05）。研究组输血前后血清EOS、hs-CRP的差值高于对照组（P <0.05）。多因素一般Logistic回归分析结果显示：输血次数> 2次［O^R=3.589（95% CI：1.477，8.724）］、发血至输血时间≥ 30 min［O^R=3.881（95% CI：1.597，9.431）］、输血前后血清EOS差值升高［O^R=2.765，95% CI：1.138，6.720）］、输血前后血清hs-CRP差值升高［O^R=3.050，95% CI：1.255，9.411）］是输血后发生不良反应的影响因素（P <0.05）。ROC曲线结果显示，输血前后血清EOS差值、输血前后血清EOS差值及两者联合预测发生不良反应的敏感性分别为70.73%（95% CI：0.419，0.753）、73.17%（95% CI：0.428，0.783）、70.73%（95% CI：0.405，0.772），特异性分别为75.00%（95% CI：0.469，0.851）、68.18%（95% CI：0.434，0.725）、88.64%（95% CI：0.573，0.912），AUC分别为0.679（95% CI：0.569，0.776）、0.644（95% CI：0.533，0.745）、0.823（95% CI：0.726，0.898）。结论 输血前后血清EOS、hs-CRP差值可用于预测输血后不良反应，且两者联合的预测价值更高。

Abstract:

Objective To analyze the predictive value of eosinophil (EOS) count combined with high-sensitivity C-reactive protein (hs-CRP) levels in adverse reactions to blood transfusion.Methods The clinical data of 85 inpatients who received blood transfusion in our hospital from May 2020 to January 2022 were retrospectively analyzed. According to whether adverse reactions occurred after blood transfusion, the patients were divided into control group (n =44, without adverse reactions after blood transfusion) and study group (n = 41, with adverse reactions after blood transfusion). Both groups received blood transfusion, and the differences of serum EOS count and hs-CRP levels before and after blood transfusion as well as the clinical data were compared between the two groups. The multivariable Logistic regression model was adopted to analyze the factors affecting the occurrence of adverse reactions to blood transfusion. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was used to analyze the predictive value of the differences of EOS count and serum levels of hs-CRP before and after blood transfusion for adverse reactions to blood transfusion.Results The proportions of patients with more than two sessions of blood transfusion and with the time from obtaining blood to blood transfusion no less than 30 minutes in the study group were higher than those in the control group (P < 0.05). There was no difference in the sex composition, age, body mass index (BMI), distribution of the department that the patients stayed, underlying diseases, history of smoking history, or history of drinking between the two groups (P > 0.05). The differences of EOS count and hs-CRP levels before and after the blood transfusion in the study group were higher than those in the control group (P < 0.05). The multivariable Logistic regression analysis demonstrated that more than two sessions of blood transfusion [O^R = 3.589, (95% CI: 1.477, 8.724) ], the time from obtaining blood to blood transfusion no less than 30 minutes [O^R = 3.881, (95% CI: 1.597, 9.431) ], increased difference of EOS count before and after blood transfusion [O^R = 2.765, (95% CI: 1.138, 6.720) ] and increased difference of serum hs-CRP levels before and after blood transfusion [O^R = 3.050, (95% CI: 1.255, 9.411) ] were factors affecting the occurrence of adverse reactions to blood transfusion (P < 0.05). The ROC curve analysis revealed that the sensitivities of the difference of EOS count before and after blood transfusion, the difference of serum hs-CRP levels before and after blood transfusion and their combination for predicting adverse reactions to blood transfusion were 70.73% (95% CI: 0.419, 0.753), 73.17% (95% CI: 0.428, 0.783), and 70.73% (95% CI: 0.405, 0.772), with the specificities being 75.00% (95% CI: 0.469, 0.851), 68.18% (95% CI: 0.434, 0.725) and 88.64% (95% CI: 0.573, 0.912), and the AUCs being 0.679 (95% CI: 0.569, 0.776), 0.644 (95% CI: 0.533, 0.745) and 0.823 (95% CI: 0.726, 0.898), respectively (P < 0.05).Conclusions The differences of EOS count and serum hs-CRP levels before and after blood transfusion can be used to predict the occurrence of adverse reactions to blood transfusion, and their combination exhibits higher predictive value.