| Objective:Severe pneumonia is the result of the aggravation of inflammation of lung tissue,and its mortality is high.By analyzing the predictive value of NLR and CT imaging scores in severe pneumonia,this study brings new ideas for the evaluation of severe pneumonia patients.Methods: A total of 150 cases were studied,which came from emergency medical and emergency intensive care unit patients with severe pneumonia who received treatment from June 2020 to May 2022.Collect the personal information,basic disease conditions,hospitalization treatment,laboratory test indicators and CT image scores within 24 hours after hospitalization,including WBC,NEU,LYM,CRP,PCT,Lac,ALT,AST,Cr,BUN,eGFR,urine protein quantification,CT image scores.(1)Using PSI assessment,the study subjects were divided into groups according to the severity of the disease(low,medium and high)shown by the assessment results.The data of each group were compared and analyzed for differences,and the correlation between these data and the severity of the disease was analyzed.(2)Using APACHE II assessment,the study subjects were divided into groups according to the severity of the disease(low,medium and high)shown by the assessment results.The data of each group were compared and analyzed,and the correlation between these data and the severity of the disease was analyzed.(3)When the results assessed by PSI and APACHE Ⅱ are used as the criteria of disease severity,the statistically significant data,indicators and scores of each group after comparative difference analysis are included in further multifactor analysis to obtain independent risk factors for severe pneumonia patients with high-risk conditions.(4)Under the guidance of PSI and APACHE Ⅱevaluation results,the ROC curve was used to analyze the predictive value of NLR and CT image scores on the high risk of severe pneumonia patients,and the best cut-off value was found.On this basis,the value of the combination of the two in predicting the high risk of severe pneumonia patients was analyzed,and the predictive value of the combination in series and parallel was analyzed respectively.(5)The statistical study subjects were divided into two groups(death group and survival group)according to the survival condition within28 days after hospitalization and based on the statistical results,and all data were compared and analyzed.(6)The data with significant differences were analyzed by multiple factors to obtain the relevant factors affecting the survival of the research object.(7)The ROC curve was used to analyze the value of NLR and CT image scores in predicting the death risk of the study object,and the best predictive cutoff value was found out.The value of the combination of the two in predicting the death risk of the study object was analyzed,and the predictive value of the series connection and the parallel connection was analyzed respectively.Results:(1)Under the grouping of PSI score and APACHE Ⅱ score,it is shown that in terms of age,length of stay,smoking history,incidence rate of coronary heart disease and COPD,invasive mechanical ventilation time,incidence rate of complication emphysema/atelectasis,respiratory failure and catheter related infection,the numerical values from high to low are high risk group>medium risk group>low risk group,and there is a significant difference between the groups(P<0.05);In terms of WBC,NLR,CRP,PCT,Lac,CT image scores,the values from high to low are high risk group>medium risk group>low risk group,and there is a significant difference between the groups(P<0.05).(2)Age,length of stay,smoking history,underlying coronary heart disease,underlying chronic obstructive pulmonary disease,invasive mechanical ventilation time,complications of emphysema/atelectasis,complications of respiratory failure,complications of catheter related infection,WBC,NLR,CRP,PCT,Lac,CT imaging scores were positively correlated with the severity of the disease under PSI score and APACHE Ⅱ score(P<0.05).(3)Under the grouping of PSI score and APACHE Ⅱ score,it is shown that: older,longer hospitalization days,basic coronary heart disease,basic COPD disease,longer invasive mechanical ventilation time,complications of emphysema/atelectasis,complications of respiratory failure,WBC,NLR,CRP,PCT The increase of Lac and the increase of CT image score were independent risk factors to promote the development of severe pneumonia patients to high risk(P<0.05).(4)Under the grouping of PSI scores,the predictive value of NLR and CT image scores for the high risk of severe pneumonia patients was 0.729 and0.768,respectively.The best evaluation threshold for the high risk of severe pneumonia patients was 11.42 and 2.05,respectively.The sensitivity was 0.745 and 0.725,the specificity was 0.904 and 0.908,and the Jordan index was 0.649 and 0.633,respectively.Under the APACHE Ⅱ scoring group,the predictive value of NLR and CT imaging scores for the high risk of severe pneumonia patients was 0.743 and 0.771,respectively.The best evaluation threshold for the high risk of severe pneumonia patients was 11.37 and 2.08,respectively.The sensitivity was 0.781 and 0.769,the specificity was 0.917 and 0.921,and the Jordan index was 0.698 and 0.690,respectively.Under the grouping of PSI score and APACHE Ⅱ score,it is shown that the combination of NLR and CT image score in parallel has the highest efficacy in predicting the high-risk condition of patients with severe pneumonia,with sensitivity of 0.881 and 0.896,specificity of 0.925 and 0.937,and Jordan index of 0.806 and 0.833,respectively.(5)In terms of age,prevalence of COPD at admission,incidence of emphysema/atelectasis and respiratory failure during treatment,NLR,CRP,PCT,Lac and CT imaging scores,the value of death group is higher than that of survival group.In terms of hospitalization and invasive ventilation,the death group took longer than the survival group(all P<0.05).(6)Higher age,COPD based diseases,emphysema/atelectasis complications,increased NLR,CRP,PCT,Lac,and CT imaging scores were independent risk factors for increased mortality in patients with severe pneumonia(P<0.05).(7)The area under the ROC curve predicted by NLR and CT imaging scores for the death of patients with severe pneumonia was 0.706 and 0.715,respectively.The best evaluation threshold for the death risk of severe pneumonia was 15.05 and 2.55,respectively.The sensitivity was 0.715 and 0.759,the specificity was 0.914 and 0.888,and the Jordan index was 0.629 and 0.647,respectively.The combination of NLR and CT imaging score in parallel has the highest efficacy in predicting the high death risk of patients with severe pneumonia.Conclusion:(1)Age increase,COPD of basic disease,complication with emphysema/atelectasis,NLR increase,CRP increase,PCT increase,Lac increase and CT image score increase are independent risk factors for the development of severe pneumonia to high risk and death.(2)NLR and CT imaging scores have good predictive value for the high risk of severe pneumonia patients.When NLR>11.3 or CT imaging score>2,it indicates that the risk of severe pneumonia patients developing to high risk increases.(3)NLR and CT imaging score have good prognostic value for patients with severe pneumonia.When NLR>15 or CT imaging score>2.5,it indicates that the risk of death of severe pneumonia is increased.The combination of NLR and CT imaging scores in parallel has a higher efficacy in predicting the condition of severe pneumonia patients. |
