The Evaluation Value Of Neutrophil/Lymphocyte Ratio In The Stratification And Prognosis Of Patients With Sepsis

Purpose:By dynamically monitoring the peripheral blood neutrophil to lymphocyte ratio(NLR)and other related indicators to evaluate the value in predicting prognosis and severity of patients with sepsis.Method:According to the inclusion and exclusion criteria,this study retrospectively collected patients with sepsis and septic shock who were admitted to the intensive care unit of the Emergency Medicine Department of Tianjin Medical University General Hospital from February 2017 to September 2019.Collecting general information of patients,white blood cell,neutrophil count,lymphocyte count,monocyte count,platelet count,average platelet volume and other relevant indicators on the 1st,3rd and 7th day of admission and calculate neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),mean platelet volume to platelet count ratio and other related indicators,and evaluate the SOFA score(sequential organ failure score)and APACHEII score(acute physiology and chronic health evaluation scoring system)on the 1st day of admission.Patients were divided into death and survival groups based on patients’ prognosis.According to sepsis 3.0 diagnostic criteria for sepsis and septic shock,they were divided into sepsis and septic shock group.Using SPSS23.0 software for statistical analysis and draw the receiver operating characteristic curve(ROC curve),evaluate the predictive value of relevant indicators on sepsis mortality,and perform multifactor logistic regression analysis to determine the risk of prognosis factor.Results:A total of 188 patients were included in this study,61 in the death group and 127 in the survival group.There were 149 patients with sepsis and 39 patients with septic shock.Between the survival group and the death group,there was no statistically significant difference in age,gender,APACHE Ⅱ score,SOFA score,PCT,D-Dimer,NLR and MPV/PC on day 1 of admission.The CRP of the survival group and the death group were 9.06(3.38,16.80)(mg/L)and 12.4(7.9,24.5)(mg/L),respectively.The CRP of the survival group was smaller than that of the death group,and the difference between the two groups was statistically significant.The D3NLR of the survival group and the death group were 9.04(5.34,15.02)and 14.27(7.29,23.03),respectively.The D3NLR of the survival group was smaller than the death group,there was a significant difference between the two groups(P<0.05).The D7NLR of the survival group and the death group were 5.94(3.85,10.10)and 10.10(6.61,16.72),respectively.The D7NLR of the survival group was smaller than the death group,and there was a significant difference between the two groups.Multivariate logistic analysis found that D7NLR(cutoff value 9.535,sensitivity 68.9%,specificity 74.8%,AUC 0.667),D7MPV/PC(cutoff value 0.062,sensitivity 72.1%,specificity 64.6%,AUC 0.669)were independent risk factor for death in sepsis patients.In the sepsis group and the septic shock group,the SOFA score,D-dimer,D1NLR,D-MPV/PC,D3NLR,D3MPV/PC,D7MPV/PC and Δ NLR3-1/D1NLR had statistical differences between the two groups.The APACHE Ⅱ score、PCT、CRP and D7NLR were not significantly different between the two groups.Conclusion:D7NLR、D7MPV/PC have the value of evaluating the prognosis of patients with sepsis.NLR and MPV/PC are related to the severity of sepsis.