The Prognostic Value Of Neutrophils/Lymphocytes In Patients With Severe Pneumonia

Objectives:To investigate the predictive value of peripheral blood neutrophils/lymp hocytes(NLR)in patients with severe pneumonia.Methods:This study is a retrospective analysis.From January 2018 to December 2018,90 patients with severe pneumonia admitted to the department of critical care of yuxi people’s hospital were selected.According to the inclusion criteria and exclusion criteria,71 patients were finally included in the study.According to the outcome of the patients,they were divided into death group(36 cases)and survival group(35 cases).Basic information was collected for both groups,including gender,age and smoking history.Laboratory indicators within 24 hours of admission included white blood cells.neutrophils ratio,neutrophils count,lymphocyte ratio,lymphocyte count,hemoglobin,hematocrit,platelet,PH,PO2,PC O2,oxygenation index,bicarbonate root,lactic acid,calcitonin,interleukin 6,hypersensitiveC-reactive protein,potassium.sodium,chloride,creatinine,ureanitrogen,NT-proBNP,albumin,proalbu min and Length of stay and mechanical ventilation.And the worst acute physiological and chronic health(APACHE Ⅱ)scores,SOFA score within 24 hours of admission and neutrophils/lymphocytes(NLR)score were calculated.After the data were sorted out,SPSS 24.0 statistical software was used to analyze the data,and the indicators with statistical differences between the two groups were analyzed by regression analysis of single-factor and multi-factor influence factors.The ROC curve was used to analyze the predictive power of NLR for the prognosis of death in patients with severe pneumonia,and whether it could be combined with other indicators to improve the efficacy of prognosis evaluation in patients with severe pneumonia.Results:1.The sex ratio of the two groups,the previous smoking history,the leng-th of hospitalization and the laboratory indicators within 24 hours of admission such as white blood cells,lymphocyte ratio,hemoglobin,erythrocyte,hemoglobin,PO2,PCO2,oxygenation index,bicarbonate root,calcitonin,hypersensitive C-reactive protein,interleukin6,potassium,sodium,chloride,creatinine,urea nitrogen,NT-proBNP,albumin and proalbumin have no statistical difference(P>0.05).2.There were statistically significant differences in age,APACHE Ⅱ score,SOFA score,mechanical ventilation duration,neutrophils ratio,neutrophils count,lymphocyte count,NLR value and lactic acid between the two groups(P<0.05).3.After binary logistic regression analysis,the results showed that NLR was an independent ri-sk factor for death in patients with severe pneumonia(OR:0.942 95%CI:0.897～0.988,P=0.015),and that the APA CHE Ⅱ score,SOFA score,neutrophils ratio,lymphocyte count and lactic acid were both independent risk factors for patients with severe pneumonia,with statistical significance(P<0.05).Age and the neutrophils count were not independent risk factors for death in patients with severe pneumonia(P>0.05).4.Drawing the ROC curve and calculating the area under the curve(AUC),the predictive power of the NLR(AUC:0.683)was only lower than the APACHE Ⅱ score(AUC:0.768)and comparable to SOFA Lac(respectively AUC:0.688,0.689).5.The cut-off value was 13.5,the sensitivity was 80.6%,and the specificity was 54.3%.Moreover,the combined prediction performance of NLR and APACHE Ⅱ,SOFA,Lac was higher than that of each indicator alone,which could increase the sensitivity and specificity.Conlusions:1.NLR can be used as an early indicator of prognosis in patients with severe pneumonia,and its predictive power is high.2.NLR,APACHE Ⅱ score,SOFA score,neutrophils ratio,lymphocyte count and lactate are independent risk factors for death in patients with severe pneumonia,and the combination of NLR with APACHE Ⅱscore,SOFA score and Lac can improve predictive evaluation,increasing sensitivity and specificity.