外周血LAR、RDW对老年多发性骨髓瘤患者发生医院感染的预测价值

Predictive value of peripheral blood LAR and RDW for hospital-acquired infection in elderly patients with multiple myeloma

摘要:

目的 探究外周血乳酸脱氢酶与白蛋白比值（LAR）、红细胞分布宽度（RDW）对老年多发性骨髓瘤（MM）患者发生医院感染的预测价值。方法 回顾性选取2018年1月—2024年6月汉中市中心医院收治的122例老年MM患者，根据是否发生医院感染分为医院感染组（55例）和无医院感染组（67例）。比较两组相关临床资料、LAR、RDW。通过多因素逐步Logistic回归模型分析老年MM患者发生医院感染的危险因素；并进行风险分层分析；绘制受试者工作特征（ROC）曲线评估LAR、RDW及其联合检测的预测效能。结果 医院感染组糖尿病患病率、住院时间、国际分期体系分期、美国东部肿瘤协作组评分、血尿素氮（BUN）、LAR、RDW均高于无医院感染组，血红蛋白水平低于无医院感染组（P <0.05）。多因素逐步Logistic回归分析结果显示：住院时间长［O^R=1.862（95% CI：1.105，3.136）］、BUN水平高［O^R=2.145（95% CI：1.319，3.487）］、LAR水平高［O^R=7.362（95% CI：2.752，19.692）］和RDW水平高［O^R=6.204（95% CI：2.407，15.988）］均为老年MM患者发生医院感染的危险因素（P <0.05）。分层分析结果表明，随着LAR升高，老年MM患者发生医院感染风险增加（P <0.00125）；随着RDW升高，老年MM患者发生医院感染风险增加（P <0.0125）；高LAR且高RDW的老年MM患者的医院感染率较高（P <0.00625）。ROC曲线结果表明，LAR、RDW及其联合检测预测老年MM患者发生医院感染的敏感性分别为72.7%（95% CI：0.590，0.839）、78.2%（95% CI：0.650，0.882）、87.3%（95% CI：0.755，0.947），特异性分别为74.6%（95% CI：0.625，0.845）、71.6%（95% CI：0.593，0.820）、91.0%（95% CI：0.815，0.966）。结论 LAR、RDW是老年MM患者发生医院感染的独立危险因素，两者联合检测能较好地预测老年MM患者发生医院感染风险。

Abstract:

Objective To investigate the predictive value of the peripheral blood lactate dehydrogenase to albumin ratio (LAR) and red cell distribution width (RDW) for hospital-acquired infection in elderly patients with multiple myeloma (MM).Methods A retrospective study was conducted on 122 elderly MM patients admitted to Hanzhong Central Hospital between January 2018 and June 2024. Patients were divided into a hospital-acquired infection group (n = 55) and a non-infection group (n = 67) based on infection occurrence. Clinical data, LAR, and RDW were compared between groups. Multivariable stepwise logistic regression analysis was performed to identify risk factors for hospital-acquired infection in elderly MM patients. Risk stratification analysis was subsequently conducted. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of LAR, RDW, and their combined detection.Results The hospital-acquired infection group had a higher prevalence of diabetes, longer length of hospital stay, higher international staging system stage, higher eastern cooperative oncology group scores, and elevated levels of BUN, LAR, and RDW compared with the non-infection group, while hemoglobin levels were significantly lower (all P < 0.05). Multivariable stepwise logistic regression analysis revealed that prolonged length of hospital stay [O^R = 1.862 (95% CI: 1.105, 3.136) ], elevated BUN levels [O^R = 2.145 (95% CI: 1.319, 3.487) ], elevated LAR [O^R = 7.362 (95% CI: 2.752, 19.692) ], and elevated RDW [O^R = 6.204 (95% CI: 2.407, 15.988) ] were all risk factors for hospital-acquired infection in elderly MM patients (P < 0.05). Stratified analysis showed that the risk of hospital-acquired infection in elderly patients with MM increased with rising LAR (P < 0.00125). Similarly, the risk increased with elevated RDW (P < 0.0125). Elderly MM patients with both high LAR and high RDW had a significantly higher incidence of hospital-acquired infection (P < 0.00625). ROC curve analysis indicated that the sensitivities of LAR, RDW, and their combined detection for predicting hospital-acquired infection in elderly MM patients were 72.70% (95% CI: 0.590, 0.839), 78.20% (95% CI: 0.650, 0.882), and 87.30% (95% CI: 0.755, 0.947), with specificities of 74.60% (95% CI: 0.625, 0.845), 71.60% (95% CI: 0.593, 0.820), and 91.00% (95% CI: 0.815, 0.966), respectively.Conclusion LAR and RDW are independent risk factors for hospital-acquired infection in elderly patients with MM. Combined detection of LAR and RDW provides good predictive performance for the risk of hospital-acquired infection in this population.