| Objective:To evaluate the value of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte(PLR)and procalcitonin(PCT)in diagnosis of bacterial infection in patient with stage 5 chronic kidney disease(CKD).Methods:Conduct a retrospective analysis.Data of 250 cases of CKD5 which treated in the Department of Nephrology,Affiliated Hospital of North Sichuan Medical College from October 31,2017 to June 30,2018.162 cases were excluded according to exclusion criteria.they were divided into bacterial infection group(n = 87),non-infection group(n = 75)and healthy control group(n = 30)were selected from the same period of physical examination center of Affiliated Hospital of North Sichuan Medical College.Single factor complete random variance analysis and independent sample t test were used to compare the differences among NLR,PLR and PCT groups.According to whether hemodialysis was performed or not,the infected group was divided into dialysis group and non-dialysis group.The levels of NLR,PLR and PCT were compared between the two groups by independent sample t test.Pearson was used to analyze the relationship between NLR,PLR and other variables.Independent correlation factors for diagnosis of bacterial infection in patients with stage 5 CKD were determined by Multivariate logistic regression analysis.Using ROC curve to evaluate the diagnostic value of indicators.The sensitivity and specificity of the three indicators in the diagnosis of bacterial infection in patients with stage 5 CKD were calculated.At the same time,the sensitivity and specificity of the combined diagnosis of two or two indicators and three indicators were calculated by a series of combined methods.Result:1.There were significant differences in NLR,PLR,hs-CRP among the three groups(P< 0.05).The infection group was the highest,followed by the non-infection group.The mean of PCT,WBC,NEUT,NE% in infected group were higher than those in non-infected group(P < 0.05).There was no significant difference in the levels of NLR,PLR and PCT between dialyzers and non-dialyzers in infection group(P > 0.05).2.NLR is positively correlated with PLR.NLR and PLR were positively correlated with high-sensitivity C-reactive protein(hs-CRP),Both were negatively correlated with prealbumin,but not with PCT.3.Multivariate logistic regression analysis showed that elevated levels of NLR and PCT were independent predictors of bacterial infection in CKD5 patients.4.ROC curve analysis showed that the areas under NLR,PLR,PCT and AUC curve were 0.75,0.60 and 0.88,respectively.The sensitivity and specificity of the three indicators for diagnosis of bacterial infection in patients with CKD5 were 68.97% and 72.00%,59.77% and 61.33%,73.56% and 94.67%,When combined detection of NLR,PLR with PCT,the sensitivity and specificity of NLR+PCT were 75.86%,97.33%,and the area under AUC curve was 0.89.When the sensitivity and specificity of PLR + PCT were 73.56%,96.00%,the area under AUC curve was 0.88.When the sensitivity and specificity of NLR + PLR were 56.30%,85.30%,the area under AUC curve was 0.75.When NLR+PLR+PCT were combined,the specificity increased significantly to 98.70%,but the sensitivity decreased to 70.10%,the area under AUC curve was 0.89.Under the condition of good specificity and sensitivity,the Cut-off values of NLR,PLR and PCT were 5.30,143.90 and 0.67 ng/ml.Conclusion:1.NLR,PLR have diagnostic value in the diagnosis of bacterial infection in patients with stage 5 CKD,but the diagnostic value of PLR is relatively poor.2.Increased levels of NLR and PCT are independent predictors of bacterial infection in CKD5 patients.3.PCT has a high value in the diagnosis of bacterial infection in patients with stage5 CKD.The combination of PCT and NLR can improve the sensitivity and specificity of diagnosis.4.In addition,we found that NLR and PLR can be used to evaluate the microinflammation status of patients with stage 5 CKD. |
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