关键词:

重症肺炎, 中性粒细胞与血小板计数比值, 预后

Abstract:

Objective　To investigate the value of the ratio of neutrophil to platelet count in the prediction of prognosis of patients with severe pneumonia. Methods　One hundred and forty-seven elderly patients with complete data diagnosed as severe pneumonia at Jinqiu Hospital from December 2018 to December 2020 were collected for the retrospective study, including 87 males and 60 females who were 65-85 years old. Taking 28 days of treatment as the observation period, the patients were divided into a survival group (118 cases) and a death group (29 cases) according to the situation after the treatment. The general data of the enrolled patients, such as gender, age, disease history, etc., were collected and recorded. The white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), absolute number of neutrophils (NEUT), platelet count (PLT), and other indicators were detected in all the patients; the NPR(NEUT/PLT) was calculated. The basic data, medical history, acute physiology, and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, WBC, CRP, PCT, PLT, Lac, NPR×100, and other indicators of the two groups before and after the treatment were compared and analyzed. The meaningful indicators screened by single factor analysis were analyzed by multifactor logistic regression analysis. NPR×100 was analyzed by receiver operating characteristic curve (ROC). χ² and t tests were applied. Results　The PLT was much higher and the levels of NPR×100, PCT, and Lac and APACHE Ⅱ score were significantly lower in the survival group than in the death group [(157.73±16.99)×10⁹/L vs. (120.48±14.06)×10⁹/L, (9.00±4.08) vs. (15.78±6.26), (12.20±3.09) ng/L vs. (14.06±3.04) ng/L, (1.04±0.27) mmol/L vs. (1.73±0.27 )mmol/L, and (22.25±5.17) vs. (29.79±4.90)], with statistical differences (t=10.916, 7.139, 2.913, 12.330, and 7.107; all P<0.05). Multivariate logistic regression analysis showed that PLT, NPR×100, and Lac were important factors for monitoring the patients' prognosis (P=0.003, 0.007, and 0.008). The area under the ROC of NPR×100 for predicting the patients' prognosis within 24 hours after admission was 0.858; the optimal cut-off value of NPR was 12.960; the sensitivity was 0.729; the specificity was 0.887; the Jordan index was 0.616. Conclusions　High APACHE Ⅱ score, high NPR, high PCT, high Lac, and low PLT can all indicate poor prognosis of patients with severe pneumonia, with good predictive value for the disease prognosis. PLT, NPR, and Lac can be used as independent risk factors for predicting 28 d mortality. NPR has a good sensitivity and a good specificity in predicting the death risk of patients with severe pneumonia, so it is worthy of further study.

Key words:

Severe pneumonia, Neutrophil to platelet count ratio, Prognosis