中性粒细胞/白蛋白比值预测严重脓毒症患儿预后的临床价值

吴忠璟; 陈亚凤; 王海岛; 翟佳羽

doi:10.3969/j.issn.2095-5227.2018.07.015

中性粒细胞/白蛋白比值预测严重脓毒症患儿预后的临床价值

Clinical value of neutrophil/albumin ratio in predicting prognosis of children with severe sepsis

摘要

摘要: 目的探讨中性粒细胞/白蛋白(neutrophil/albumin，NEU/Alb)比值对严重脓毒症患儿预后的评估价值。方法选取2014年1月- 2017年3月海口市妇幼保健院收治的严重脓毒症患儿158例，根据其28 d生存情况分为存活组(113例)和死亡组(45例)。检测两组患儿治疗后0 h、24 h、72 h的NEU、Alb及NEU/Alb比值变化，并记录入院时APACHEⅡ、PCIS评分情况。应用受试者工作特征(ROC)曲线分析NEU、Alb及NEU/Alb对严重脓毒症患儿预后的评估价值。Pearson相关分析死亡患儿NEU/Alb与APACHEⅡ、PCIS评分的相关性。结果死亡组0 h、24 h、72 h的NEU及NEU/Alb均明显高于存活组 NEU(×10⁹/L)：12.46±4.05 vs 9.82±3.37，15.74±4.80 vs 8.56±3.20，18.42±5.27 vs 6.38±2.45，NEU/Alb ：0.52±0.20 vs 0.35±0.13，0.74±0.26 vs 0.33±0.14，1.05±0.42 vs 0.16±0.08；P均< 0.05；而死亡组 0 h、24 h、72 h 的Alb明显低于存活组 Alb(g/L)：25.18±4.72 vs 28.14±5.20，22.24±4.30 vs 30.15±5.63，19.38±3.81 vs 36.28±6.94，P均< 0.05。ROC曲线显示，72 h NEU/Alb评估严重脓毒症患儿预后的AUC(95% CI)最高0.908(0.848 ～ 0.971)，明显优于其他指标(P均< 0.05)，其预测严重脓毒症患儿死亡的敏感度(90.4%)和特异度(84.0%)最高。相关分析显示，死亡患儿72 h NEU/Alb与APACHEⅡ评分呈正相关(r=0.708，P< 0.01)，72 h NEU/Alb与PCIS评分呈负相关(r=-0.682，P< 0.01)。结论 NEU/Alb比值变化与严重脓毒症患儿病情的严重程度及预后相关，72 h NEU/Alb比值可准确判断严重脓毒症患儿的预后。

Abstract: Objective To assess the value of neutrophil/albumin (NEU/Alb) ratio in predicting prognosis of children with severe sepsis. Methods One hundred and fi fty-eight cases with severe sepsis treated in Haikou Maternal and Child Health Care Hospital from January 2014 to March 2017 were divided into survival group (n=113) and death group (n=45) according to their 28-day survival. The changes of neutrophil count (NEU), albumin (Alb) and NEU/Alb ratio at 0 hour, 24 hours, and 72 hours after treatment in two groups were detected, and the APACHEⅡ and PCIS scores at admission were recorded. The evaluation value of NEU, Alb and NEU/Alb in predicting the prognosis of children with severe sepsis was analyzed by ROC curve. Correlation between NEU/Alb and APACHEⅡ, PCIS scores in dead children was analyzed by Pearson correlation analysis. Results NEU and NEU/Alb in the death group were significantly higher than those in the survival group at 0 hour, 24 hours and 72 hours after treatmentNEU(×10⁹/L):(12.46±4.05) vs (9.82±3.37), (15.74±4.80) vs (8.56±3.20), (18.42±5.27) vs (6.38±2.45); NEU/Alb:(0.52±0.20)vs (0.35±0.13), (0.74±0.26) vs (0.33±0.14), (1.05±0.42) vs (0.16±0.08), all P< 0.05. Alb in the death group was significantly lower than that in the survival group at 0 hour, 24 hours and 72 hours after treatmentAlb(g/L):(25.18±4.72) vs (28.14±5.20), (22.24±4.30) vs (30.15±5.63), (19.38±3.81) vs (36.28±6.94), all P< 0.05. The ROC curve analysis showed that NEU/Alb at 72 hours after treatment predicted prognosis of severe sepsis children with greatest AUC (95% CI)0.908 (0.848-0.971), sensitivity(90.4%) and specificity (84.0%) compared with other indicators (all P< 0.05). Correlation analysis showed that 72 hours NEU/Alb was positively correlated with APACHEⅡscore (r=0.708, P< 0.01), and negatively correlated with PCIS score (r=-0.682, P< 0.01). Conclusion The change of NEU/Alb ratio is associated with the severity and prognosis of children with severe sepsis, and the 72 hours NEU/Alb ratio can optimally predict the prognosis of children with severe sepsis.

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