24 h血乳酸清除率联合NLR、PCT对重症监护病房重症肺炎28 d病死风险的预测价值分析

Predictive value of 24 h blood lactate clearance combined with NLR and PCT on 28 day mortality risk of severe pneumonia in ICU

摘要:

目的 研究24 h血乳酸（Lac）清除率联合外周血中性粒细胞与淋巴细胞比值（NLR）、降钙素原（PCT）对重症监护病房（ICU）重症肺炎患者28 d病死风险的预测价值。方法 回顾性选取2017年12月—2021年12月安徽皖北煤电集团总医院78例重症肺炎患者作为研究对象，根据28 d临床结局将其分为病死组27例和存活组51例。比较两组的一般资料、24 h Lac清除率、NLR、PCT，采用多因素一般Logistic回归模型分析28 d内病死的影响因素，采用受试者工作特征（ROC）曲线评估24 h Lac清除率联合NLR、PCT对28 d内病死风险的预测价值。结果 两组的性别、年龄、吸烟史、基础疾病、氧合指数、体温、平均动脉压、白细胞计数、血小板计数、抗菌药物使用时间比较，差异均无统计学意义（P >0.05）；病死组肺炎严重程度评分（PSI）、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、机械通气治疗占比均高于存活组（P <0.05）；病死组24 h Lac清除率低于存活组，NLR、PCT水平高于存活组（P <0.05）；经多因素一般Logistic回归分析，PSI评分［O^R=9.440（95% CI：4.108，21.697）］、APACHEⅡ评分［O^R=3.904（95% CI：1.699，8.972）］、24 h Lac清除率［O^R=5.068（95% CI：2.205，11.648）］、NLR［O^R=8.199（95% CI：3.567，18.843）］、PCT［O^R=5.766（95% CI：2.509，13.252）］均为28 d内病死的影响因素（P <0.05）；ROC曲线分析结果显示，24 h Lac清除率、NLR、PCT预测28 d内病死的最佳截断值为26.10%、5.95和11.27 μg/L，敏感性为81.48%（95% CI：0.613，0.930）、59.26%（95% CI：0.390，0.770）、66.67%（95% CI：0.460，0.828），特异性为72.55%（95% CI：0.580，0.837）、82.35%（95% CI：0.686，0.911）、90.20%（95% CI：0.778，0.963），AUC值为0.809（95% CI：0.704，0.889）、0.736（95% CI：0.624，0.830）、0.802（95% CI：0.697，0.884），联合预测的敏感性为92.59%（95% CI：0.742，0.987）、特异性为86.27%（95% CI：0.731，0.938）、AUC值为0.946（95% CI：0.871，0.985）。结论 ICU重症肺炎28 d内病死患者的24 h Lac清除率、NLR、PCT明显异常变化，其对预后评估具有良好预测价值。

Abstract:

Objective To study the predictive value of 24-hour blood lactic acid (LAC) clearance combined with peripheral blood neutrophil lymphocyte ratio (NLR) and procalcitonin (PCT) on the 28 day death risk of severe pneumonia in intensive care unit (ICU).Methods Seventy-eight patients with severe pneumonia in General Hospital of Wanbei Coal-Electricity Group from December 2017 to December 2021 were selected as the research object, and they were divided into death group (n = 27) and survival group (n = 51) according to the 28 day death. The general data, 24 h lac clearance, NLR and PCT of the two groups were compared. The influencing factors of death within 28 d were analyzed by logistic regression, and the predictive value of 24 h lac clearance combined with NLR and PCT on the risk of death within 28 d was evaluated by ROC.Results There was no significant difference between the two groups in gender, age, smoking history, basic diseases, oxygen and index, body temperature, map, WBC, PLT and the use time of antibiotics (P > 0.05). The PSI score, Apache Ⅱ score and the proportion of mechanical ventilation treatment in the death group were higher than those in the survival group (P < 0.05). The 24 h lac clearance rate in the death group was lower than that in the survival group, and the levels of NLR and PCT were higher than those in the survival group (P < 0.05). Logistic regression analysis showed that PSI score [O^R =9.440 (95% CI: 4.108, 21.697) ], Apache Ⅱ score [O^R = 3.904 (95% CI: 1.699, 8.972) ], 24 h lac clearance rate [O^R =5.068 (95% CI: 2.205, 11.648) ], NLR [O^R = 8.199 (95% CI: 3.567, 18.843) ] and PCT [O^R = 5.766 (95% CI: 2.509, 13.252) ] were the influencing factors of death within 28 d (P < 0.05). ROC analysis showed that the cut off values of 24-hour lac clearance, NLR and PCT predicted death within 28 days were 26.10%, 5.95 and 11.27 μg/L; the sensitivity was 81.48% (95% CI: 0.613, 0.930), 59.26% (95% CI: 0.390, 0.770), and 66.67% (95% CI: 0.460, 0.828), respectively; the specificity was 72.55% (95% CI: 0.580,0.837), 82.35% (95% CI: 0.686, 0.911), 90.20% (95% CI:0.78,0.963), respectively; the AUC values were 0.809 (95% CI：0.704，0.889), 0.736 (95% CI：0.624, 0.830), 0.802 (95% CI：0.697, 0.884), respectively. The sensitivity of joint prediction was 92.59% (95% CI: 0.742, 0.987), the specificity was 86.27% (95% CI: 0.731, 0.938), and the AUC value was 0.946 (95% CI: 0.871, 0.985).Conclusion 24 h lac clearance, NLR and PCT showed significant abnormal changes in patients who died within 28d of severe pneumonia in ICU, which has good predictive value for prognosis evaluation.