目的

探讨中性粒细胞与淋巴细胞比值（NLR）对老年重症社区获得性肺炎（SCAP）进展为脓毒症的预测价值。

方法

选取2022 年1 月至2023 年10 月陕西省咸阳市旬邑县医院收治的老年SCAP 患者78 例作为研究对象，根据是否进展为脓毒症分为脓毒症组（24 例）和非脓毒症组（54 例）。采用t 检验或χ² 检验对两组患者的相关资料进行单因素分析，采用多因素Logistic 回归分析老年SCAP 进展为脓毒症的影响因素，并采用受试者工作特征（ROC）曲线评价NLR 的预测价值。

结果

单因素分析结果显示，脓毒症组急性生理和慢性健康状况评分Ⅱ、PCT、NLR、中性粒细胞计数、淋巴细胞计数较非脓毒症组高（P ＜0.05）；多因素Logistic回归分析结果显示，APACHE-Ⅱ（OR=1.476，95%CI：1.051 ～2.071）、PCT（OR=1.975，95%CI：1.295 ～3.012）、NLR（OR=1.958，95%CI：1.259 ～3.045）为老年SCAP 进展为脓毒症的危险因素（P ＜0.05）。ROC 曲线分析结果显示，NLR 预测老年SCAP 进展为脓毒症的曲线下面积为0.858（95%CI：0.778 ～0.939），高于APACHE-Ⅱ和PCT。

结论

NLR 可以有效预测老年SCAP 进展为脓毒症的风险，且检测迅速、简便，值得临床推广。

Objective

To investigate the predictive value of neutrophil-to-lymphocyte ratio（NLR） in the progression of severe community-acquired pneumonia （SCAP） to sepsis in elderly patients.

Methods

A total of 78 elderly patients with SCAP admitted to Xunyi County Hospital in Xianyang City from January 2022 to October 2023 were selected as the study objects. According to whether they progressed to sepsis， the subjects were divided into sepsis group （n=24） and non-sepsis group （n=54）.T test or χ² test were used for univariate analysis of the relevant data of the two groups. Multivariate Logistic regression was used to analyze the factors influencing the progression of SCAP to sepsis in elderly patients， and receiver operating characteristics （ROC） curve was used to evaluate the predictive value of NLR.

Results

The results of univariate analysis showed that the acute physiology and chroni health evaluation （APACHE） Ⅱ score， procalcitonin （PCT）， NLR， neutrophil count and lymphocyte count were higher in the sepsis group than those in the non-sepsis group （P ＜ 0.05）. Multivariate Logistic regression analysis showed that APACHE-Ⅱ score （OR=1.476， 95%CI: 1.051-2.071）， PCT （OR=1.975，95%CI: 1.295-3.012）， NLR （OR=1.958， 95%CI: 1.259-3.045） were risk factors for the progression of SCAP to sepsis in the elderly （P ＜ 0.05）. ROC curve analysis showed that the area under the curve of NLR for predicting SCAP progression to sepsis in the elderly was 0.858 （95%CI: 0.778-0.939）， which was higher than those of APACHE-Ⅱ score and PCT.

Conclusion

The NLR can effectively predict the risk of SCAP progression to sepsis in the elderly， and the detection is rapid and simple， which is worthy of clinical promotion.