Predictive value of neutrophil/lymphocyte ratio and C-reactive protein/lymphocyte ratio for 28-day mortality in elderly patients with sepsis

doi:10.3877/cma.j.issn.2095-8757.2023.02.005

Abstract

Abstract:

Objective

To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) and C-reactive protein/lymphocyte ratio (CLR) for 28-day mortality in elderly patients with sepsis.

Methods

A total of 330 elderly patients with sepsis admitted to Zhejiang Hospital from January 2017 to January 2021 were selected, and their general information, clinical examination indicators, and survival after 28 days of follow-up were collected. Univariate analysis (including t test, rank sum test and χ² test) was used to compare various indicators of patients in the survival group and the death group. Logistic regression was used to analyze independent risk factors of death at 28 days. Receiver operating characteristic (ROC) curve was drawn, and area under the curve (AUC) was used to evaluate the prognostic value of relevant indicators.

Results

There were 177 patients in the survival group and 153 in the death group. There were statistically significant differences in acutephysiologyandchron-icheadlthevaluation (APACHEⅡ) score, albumin, proportion of renal dysfunction, procalcitonin (PCT), C-reactive protein, lactic acid, NLR, CLR, and C-reactive protein/albumin ratio (CAR) between the two groups (t=-19.345, 2.765; χ²=4.905; Z=-7.672, -8.118, -5.826, -7.209, -9.992, -8.354; P < 0.05 or P < 0.01). NLR, CLR, PCT, lactic acid and APACHEⅡ scores were independent risk factors for 28-day prognosis in elderly patients with sepsis (P < 0.05 or P < 0.01). The predictive value of CLR was significantly higher than that of NLR and PCT (95%CI=0.036-0.142, 0.005-0.144; P < 0.05 or P < 0.01), and the predictive value of CLR+PCT was significantly higher than that of NLR+PCT (95%CI=0.006-0.092, P < 0.05).

Conclusion

For prediction of short-term prognosis in elderly sepsis patients, CLR has an advantage over PCT, and the combination of the two has greater predictive value.

Key words: Neutrophil/lymphocyte ratio, Platelet/lymphocyte ratio, C-reactive protein/lymphocyte ratio, C-reactive protein/albumin ratio, Procalcitonin, Sepsis

Li’na Chen, Yihua Yu, Liang Xu, Shijin Gong, Yueben Wang. Predictive value of neutrophil/lymphocyte ratio and C-reactive protein/lymphocyte ratio for 28-day mortality in elderly patients with sepsis[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2023, 10(02): 28-32.

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References 28

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组别	例数	年龄（岁）	男/女（例）	APACHEⅡ评分	感染部位
组别	例数	年龄（岁）	男/女（例）	APACHEⅡ评分	呼吸系统	消化系统	泌尿系统	皮肤/软组织	导管相关	其他
存活组	177	83.1±9.9	134/43	20.53±2.91	85	16	23	8	25	20
死亡组	153	84.6±9.3	101/52	27.50±3.64	89	22	11	6	16	9
检验值		t=-1.440	χ²=3.761	t=-19.345	χ²=3.390	χ²=2.296	χ²=2.992	χ²=0.072	χ²=1.014	χ²=3.004
P值		>0.05	>0.05	<0.01	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	基础疾病						白细胞（×10⁹/L）	血红蛋白（g/L）	白蛋白（g/L）
组别	例数	糖尿病	高血压	肝功能不全	肾功能不全	心血管疾病	脑血管疾病	白细胞（×10⁹/L）	血红蛋白（g/L）	白蛋白（g/L）
存活组	177	73	124	21	48	95	110	14.88±8.11	90.49±22.40	30.53±4.20
死亡组	153	59	108	19	59	89	82	14.89±8.12	87.25±22.19	29.26±4.12
检验值		χ²=0.246	χ²=0.011	χ²=0.024	χ²=4.905	χ²=0.673	χ²=2.467	t=-0.002	t=1.316	t=2.765
P值		>0.05	>0.05	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05	<0.01
组别	例数	降钙素原（ng/mL）	C反应蛋白（mg/L）	乳酸（mmol/L）	NLR	PLR	CLR	CAR
存活组	177	3.67（1.17，12.82）	71.67（39.54，113.22）	2.40（1.50，3.35）	16.27（8.00，24.84）	208.33（109.38，356.88）	98.35（42.16，179.16）	2.31（1.32，3.78）
死亡组	153	10.94（7.16，32.70）	132.29（83.61，200.00）	3.40（2.30，5.30）	29.00（15.55，51.17）	240.00（116.41，400.00）	314.65（174.42，638.88）	4.93（2.85，6.98）
检验值		Z=-7.672	Z=-8.118	Z=-5.826	Z=-7.209	Z=-0.938	Z=-9.992	Z=-8.354
P值		<0.01	<0.01	<0.01	<0.01	>0.05	<0.01	<0.01

组别	例数	年龄（岁）	男/女（例）	APACHEⅡ评分	感染部位
组别	例数	年龄（岁）	男/女（例）	APACHEⅡ评分	呼吸系统	消化系统	泌尿系统	皮肤/软组织	导管相关	其他
存活组	177	83.1±9.9	134/43	20.53±2.91	85	16	23	8	25	20
死亡组	153	84.6±9.3	101/52	27.50±3.64	89	22	11	6	16	9
检验值		t=-1.440	χ²=3.761	t=-19.345	χ²=3.390	χ²=2.296	χ²=2.992	χ²=0.072	χ²=1.014	χ²=3.004
P值		>0.05	>0.05	<0.01	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	基础疾病						白细胞（×10⁹/L）	血红蛋白（g/L）	白蛋白（g/L）
组别	例数	糖尿病	高血压	肝功能不全	肾功能不全	心血管疾病	脑血管疾病	白细胞（×10⁹/L）	血红蛋白（g/L）	白蛋白（g/L）
存活组	177	73	124	21	48	95	110	14.88±8.11	90.49±22.40	30.53±4.20
死亡组	153	59	108	19	59	89	82	14.89±8.12	87.25±22.19	29.26±4.12
检验值		χ²=0.246	χ²=0.011	χ²=0.024	χ²=4.905	χ²=0.673	χ²=2.467	t=-0.002	t=1.316	t=2.765
P值		>0.05	>0.05	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05	<0.01
组别	例数	降钙素原（ng/mL）	C反应蛋白（mg/L）	乳酸（mmol/L）	NLR	PLR	CLR	CAR
存活组	177	3.67（1.17，12.82）	71.67（39.54，113.22）	2.40（1.50，3.35）	16.27（8.00，24.84）	208.33（109.38，356.88）	98.35（42.16，179.16）	2.31（1.32，3.78）
死亡组	153	10.94（7.16，32.70）	132.29（83.61，200.00）	3.40（2.30，5.30）	29.00（15.55，51.17）	240.00（116.41，400.00）	314.65（174.42，638.88）	4.93（2.85，6.98）
检验值		Z=-7.672	Z=-8.118	Z=-5.826	Z=-7.209	Z=-0.938	Z=-9.992	Z=-8.354
P值		<0.01	<0.01	<0.01	<0.01	>0.05	<0.01	<0.01

相关因素	B值	SE	χ²值	OR值	95%CI	P值
NLR	0.042	0.019	4.882	1.043	1.005~1.083	<0.05
CLR	0.004	0.002	7.562	1.004	1.001~1.007	<0.01
CAR	-0.239	0.688	0.121	0.787	0.204~3.034	>0.05
C反应蛋白	0.022	0.024	0.876	1.023	0.976~1.072	>0.05
降钙素原	0.047	0.018	6.817	1.048	1.012~1.085	<0.01
乳酸	0.415	0.131	10.035	1.514	1.171~1.957	<0.01
白蛋白	-0.092	0.127	0.521	0.912	0.712~1.170	>0.05
APACHEⅡ评分	0.641	0.086	55.919	1.899	1.605~2.247	<0.01
常量	-18.374	4.577	16.119	0.000	-	0.000

相关因素	B值	SE	χ²值	OR值	95%CI	P值
NLR	0.042	0.019	4.882	1.043	1.005~1.083	<0.05
CLR	0.004	0.002	7.562	1.004	1.001~1.007	<0.01
CAR	-0.239	0.688	0.121	0.787	0.204~3.034	>0.05
C反应蛋白	0.022	0.024	0.876	1.023	0.976~1.072	>0.05
降钙素原	0.047	0.018	6.817	1.048	1.012~1.085	<0.01
乳酸	0.415	0.131	10.035	1.514	1.171~1.957	<0.01
白蛋白	-0.092	0.127	0.521	0.912	0.712~1.170	>0.05
APACHEⅡ评分	0.641	0.086	55.919	1.899	1.605~2.247	<0.01
常量	-18.374	4.577	16.119	0.000	-	0.000

指标	AUC	95%CI	敏感度（%）	特异度（%）	约登指数
CLR	0.819	0.774~0.863	74.5	76.3	0.508
NLR	0.730	0.677~0.8783	43.8	88.7	0.325
PCT	0.745	0.692~0.798	90.8	54.8	0.546
NLR+PCT	0.786	0.738~0.834	60.1	83.6	0.437
CLR+PCT	0.835	0.793~0.877	68.6	81.4	0.500

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