Clinical Study On The Predictive Value Of Neutrophil/Lymphocyte Ratio And Platelet/Lymphocyte Ratio For The Severity Of Sepsis In Children

OBJECTS: Although neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)have been widely studied in several diseases,their role in children’s sepsis is still unclear.Our study aimed to evaluate the predictive significance of NLR and PLR for septic shock in pediatric intensive care unit(PICU).METHODS: We retrospectively collected 140 children with sepsis who were admitted to PICU of Gansu Maternal and Child Health Hospital from March 2018 to March 2021 as the research object.According to the severity of sepsis,they were divided into sepsis group(83cases)and septic shock group(57 cases).Demography and related baseline data,first blood gas analysis,blood routine and laboratory indexes in blood biochemistry were compared between the two groups.The risk factors of septic shock in children were evaluated by univariate and multivariate logistic regression analysis.Draw ROC curve and compare the predictive value of NLR and PLR.RESULTS: The PH and LYM in septic shock group were lower than those in sepsis group,and the difference was statistically significant(P < 0.05).Lac,NLR,PLR and serum cystatin C in septic shock group were higher than those in sepsis group,and the difference was statistically significant(P < 0.05).Univariate logistic regression showed that Lac(P=0.012),LYM(P<0.001),NLR(P=0.043),PLR(P=0.008)and Cys C(P=0.005)were the risk factors of septic shock.In multivariate logistic regression analysis,Lac(P=0.006),LYM(P<0.01),NLR(P=0.024)and Cys C(P=0.008)were related to the occurrence of septic shock.Lac,LYM,NLR and Cys C are 0.707,0.732,0.706 and 0.634 under the ROC curve for predicting septic shock in children,respectively.The AUC area for predicting septic shock in children is slightly larger than that of LYM,which is 0.732,but the sensitivity of NLR is obviously higher than that of LYM.The combined detection of NLR and Lac can predict the area under ROC curve of children with septic shock to be 0.717[95%CI(0.633,0.800)].When the cutoff value is 0.31,the sensitivity is 96.5% and the specificity is 42.2%.The area under the curve of NLR and Lac joint detection increased,and the sensitivity also increased.CONCLUSIONS:1.Among Lac,LYM,NLR and Cys C,the initial NLR value at admission of PICU is the most useful biomarker for predicting septic shock in pediatric patients.Other markers have certain reference value.2.In multivariate logistic regression analysis,it was found that Lac,LYM,NLR and Cys C were related to the occurrence of septic shock in children,while PLR was not related to the occurrence of septic shock.3.NLR can predict septic shock to some extent,and the combined detection of NLR and Lac suggests that it can improve the prediction accuracy of septic shock in children.