MHR、LMR、NLR对重症肺炎合并脓毒症患者预后的预测价值

Prognostic value of MHR, LMR and NLR in patients with severe pneumonia complicated by sepsis

摘要:

目的 探讨单核细胞与高密度脂蛋白胆固醇比值（MHR）、淋巴细胞与单核细胞比值（LMR）、中性粒细胞与淋巴细胞比值（NLR）对重症肺炎合并脓毒症患者预后的预测价值。方法 选取2021年3月—2024年8月无锡市人民医院收治的重症肺炎合并脓毒症患者99例，按30 d存活情况将其分成生存组、死亡组。比较两组患者的临床资料、MHR、LMR及NLR；采用多因素一般Logistic回归模型分析重症肺炎合并脓毒症患者死亡的影响因素，并绘制受试者工作特征（ROC）曲线分析预测价值。结果 随访30 d，99例患者病死率为24.24%。死亡组脓毒症休克率、入院时急性生理学和慢性健康状况评估Ⅱ评分、入院时序贯器官衰竭评分和C反应蛋白水平均高于生存组（P <0.05）。死亡组MHR、LMR和NLR水平均高于生存组（P <0.05）。多因素一般Logistic回归分析，结果显示：脓毒症休克［O^R=4.821（95% CI：2.119，10.967）］、MHR高水平［O^R=3.615（95% CI：1.589，8.223）］、LMR高水平［O^R=3.714（95% CI：1.632，8.448）］、NLR高水平［O^R=4.125（95% CI：1.813，9.383）］均为重症肺炎合并脓毒症患者死亡的危险因素（P <0.05）。ROC曲线结果显示，MHR、LMR、NLR及三者联合预测重症肺炎合并脓毒症患者死亡的敏感性分别为79.2%、83.3%、83.3%、91.7%，特异性分别为84.0%、73.3%、82.7%、93.3%，曲线下面积分别为0.797、0.803、0.841、0.905。结论 MHR、LMR、NLR在预测重症肺炎合并脓毒症患者预后中具有重要价值，且三者联合检测预测价值更高。

Abstract:

Objective To analyze the predictive efficacy of the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-lymphocyte ratio (NLR) for the prognosis of patients with severe pneumonia complicated by sepsis.Methods Ninety-nine patients with severe pneumonia complicated by sepsis admitted to Wuxi People's Hospital between March 2021 and August 2024 were enrolled. Patients were divided into a survival group and a mortality group based on 30-day survival status. Clinical data, MHR, LMR, and NLR were compared between groups. Multivariable logistic regression was used to analyze the factors affecting the mortality, with receiver operating characteristic (ROC) curves assessing their predictive value.Results At 30-day follow-up, mortality reached 24.24%. The mortality group had significantly higher rates of septic shock, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at admission, Sequential Organ Failure Assessment (SOFA) scores at admission, and C-reactive protein (CRP) levels compared to the survival group (P < 0.05). The MHR, LMR, and NLR in the mortality group were also significantly higher than those in the survival group (P < 0.05). Multivariable logistic regression analysis revealed that septic shock [O^R = 4.821 (95% CI: 2.119, 10.967) ], high MHR [O^R = 3.615 (95% CI: 1.589, 8.223) ], high LMR [O^R = 3.714 (95% CI: 1.632, 8.448) ], and high NLR [O^R = 4.125 (95% CI: 1.813, 9.383) ] were all risk factors for mortality in patients with severe pneumonia complicated by sepsis (P < 0.05). ROC curve analysis demonstrated that the sensitivities of MHR, LMR, NLR, and their combination in predicting mortality in patients with severe pneumonia complicated by sepsis were 79.2%, 83.3%, 83.3%, and 91.7%, with the specificities being 84.0%, 73.3%, 82.7%, and 93.3%, and the areas under the curves being 0.797, 0.803, 0.841, and 0.905, respectively.Conclusion MHR, LMR, and NLR demonstrate significant predictive value for the prognosis of patients with severe pneumonia complicated by sepsis, with their combination yielding enhanced predictive efficacy.