Clinical Study Of NLR,RDWCV,MPV And The Extent Of Disease And Prognosis In Patients With Sepsis

Objective: To explore the relationship between severity and prognosis of sepsis patients in Intensive care unit(ICU)and NLR,RDWCV and MPV,so as to explore whether NLR,RDWCV and MPV have clinical value in predicting sepsis.Methods: Patients with sepsis treated in the Emergency Intensive Care Unit,the first ward of ICU and the second ward of ICU of the First Affiliated Hospital of Guangxi Medical University from September 2017 to September 2020 were selected.To select venous or arterial blood samples as test specimens within 24 hours of admission,Blood routine tests of patients included Neutrophile count(Neu),Lymphocyte count(Lym),Mean platelet volume(MPV)and Red blood cell distribution width coefficient of variation(RDWCV),blood coagulation four,liver and kidney functions such as data,collect hospital basic information(sex,age,infection),statistical SOFA score and APACHE Ⅱ score,The Neutrophile-Lymphocyte ratio(NLR)was determined.Grouping methods: 1.According to the disease degree,they were divided into sepsis group and septic shock group;2.According to the outcome at discharge,they were divided into survival group and non-survival group.The differences between the above two groups were compared and multifactorial logistic regression analysis was performed to explore the independent influencing factors of septic shock and death.The receiver-operating characteristic curve(ROC)explore NLR,MPV,RDWCV prediction value of sepsis patients with septic shock and death.Results: 1.Comparison of various data between sepsis and septic shock groups: NLR,MPV,RDWCV,Lac,PCT,AST,ALT,CK-MB and D-dimer were all higher in patients in the septic shock group than in the sepsis group,all P<0.05,while gender,PLT,Neu,Lym,CRP,age,WBC,albumin,haemoglobin and urea The differences were not statistically significant(all P>0.05).2.Comparison of data between survival group and non-survival group: NLR,MPV,RDWCV,LAC,AST,urea,SOFA score,APACHEⅡ score and CK-MB score in non-survival group were higher than those in survival group,all P<0.05;Compared with the survival group,the number of days in ICU,hemoglobin and albumin in the non-survival group decreased,all P<0.05;However,gender,age,CRP,PCT,ALT,creatinine and other data had no statistical significance between the two groups(all P>0.05).It is suggested that NLR,MPV,RDWCV,LAC,AST,urea,CK-MB,SOFA score,APACHEⅡ score,number of days in ICU,hemoglobin and albumin have certain influence on the clinical outcome of sepsis.3.Multi-factor logistic regression analysis of the degree of illness in patients with sepsis showed an OR and 95% CI of 1.109(95% CI: 1.002-1.245)for NLR;an OR and 95% CI of 1.032(95% CI: 1.005-1.06)for PCT;and an OR and 95% CI of 2.059(95% CI.1.008-4.208);P <0.05.4.Multi-factor logistic regression analysis of prognosis in patients with sepsis showed an OR and 95% CI of 0.664(95% CI: 0.474-0.931)for SOFA score;1.054(95% CI: 1.012-1.112)for NLR;and 1.151 for APACHE II score(95% CI: 1.031-1.284);P<0.05.5.The results of the ROC curve analysis for the assessment of sepsis severity showed that the area under the curve(AUC)and 95% CI for MPV was0.613(0.525-0.695),with a specificity of 77.55%,sensitivity of 41.58% and best cut-off value of 10.12.The AUC and 95% CI for NLR was 0.695(0.61-0.771),with a specificity of 87.76%,sensitivity of 46.53% and best cut-off value of19.96;the AUC and 95% CI for RDWCV was 0.623(0.535-0.705),with a specificity of 65.31% and sensitivity of 52.96.The AUC and 95% CI for the combined index(MPV,NLR,RDWCV)was 0.724(0.64-0.797)with a sensitivity of 70.3% and specificity of 65.31%;the AUC and 95% CI for the PCT was 0.688(0.688).The AUC and 95% CI for PCT was 0.688(0.602-0.765),with a sensitivity of 75.28%,specificity of 60.87% and an optimal cut-off value of 5.39.6.ROC curve analysis of NLR,MPV and RDWCV for prognosis prediction of sepsis patients showed that the AUC and 95% CI for APACHE II score was0.726(0.522-0.879),with a specificity of 90.24%,sensitivity of 48.98% and best cut-off value of 23;AUC and 95% CI for SOFA score was 0.771(0.569-0.909),with a specificity of 76.47%,sensitivity of 80% and best cut-off value of 9;the AUC and 95% CI for MPV was 0.7(0.494-0.86),with a sensitivity of 90.12%,specificity of 42.86% and best cut-off value of 8.83;the AUC and 95% CI for NLR was 0.594(0.389-0.777),with a specificity of 85.71%,a sensitivity of39.51% and an optimal cut-off value of 22.25;the AUC and 95% CI for RDWCV was 0.812(0.616-0.935),with a sensitivity of 86.42%,a specificity of41.43% and an optimal cut-off value of 0.14;the AUC and 95% CI for the combined indices(MPV,NLR,RDWCV)had an AUC and 95% CI of0.794(0.596-0.935),a sensitivity of 79.01% and a specificity of 60%.Conclusions: 1.NLR,MPV and RDWCV correlate with the degree of sepsis and prognosis,and can be used as one of the indicators to determine the severity of the disease,all of which have some diagnostic value.2.In this study,the combination of NLR,MPV and RDWCV can increase the evaluation efficiency of sepsis disease severity and prognosis.