The Value Of Dynamic Monitoring Of Blood Cell Subtype Ratio And PCT In The Prognosis Evaluation Of Severe Pneumonia

Objective:To explore the predictive value of blood cell subtype ratio and procalcitonin level for 28-day mortality risk of severe pneumonia by monitoring the level and its changing trend in patients with severe pneumonia.Methods:Patients diagnosed with "severe pneumonia" in the Department of Respiratory and Critical Care Medicine and the Department of Critical Care Medicine of the First Hospital of Shanxi Medical University from October 2020 to October 2022 were selected.A total of 140 patients were screened according to the inclusion and exclusion criteria.The general demographic characteristics(gender,age,height,weight),smoking history,drinking history,comorbidities,complications and other general data of the patients were collected.According to the 28-day prognosis,the patients were divided into survival group and death group,and NEUT,LYMPH,PLT and PCT were collected on the 1st,3rd,5th,and 7th day after admission.NLR,PLR and NLPR were calculated according to the above values,and the changes and differences of blood cell subtype ratio and PCT between the survival group and the death group were compared.According to the results of the study,the factors affecting the prognosis of severe pneumonia were screened out,and the single factors with statistical significance were included for Logistic regression analysis.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was used to evaluate the predictive value of blood cell subtype ratio and PCT at different time points for the 28-day mortality risk of severe pneumonia.Results:(1)General conditions of patients with severe pneumonia: A total of 140 patients with severe pneumonia were retrospectively analyzed in this study.Among the 140 patients with severe pneumonia,93(66.4%)were male and 47(33.6%)were female.81cases(57.9%)were 65 years old or older,and 59 cases(42.1%)were younger than 65 years old.There were 64 cases(45.7%)with normal BMI(18.5≤BMI < 24),27 cases(19.3%)with emaciation(BMI < 18.5),and 49 cases(35%)with overweight or obesity(BMI≥24).There were 62 patients(44.3%)with smoking history and 78 patients(55.7%)without smoking history.There were 29 patients(20.7%)with a history of drinking and 111 patients(79.3%)without a history of drinking.There were 68 cases(48.6%)with hypertension and 72 cases(51.4%)without hypertension.There were 50patients(35.7%)with diabetes and 90 patients(64.3%)without diabetes.There were 19patients(13.6%)with COPD and 121 patients(86.4%)without COPD.(2)Comparison of clinical data between survival group and death group of patients with severe pneumonia: There were significant differences between the survival group and the death group in age,drinking history,proportion of mechanical ventilation,proportion of septic shock,PCT-5d,PCT-7d,NLR-1d,NLR-3d,NLR-5d,NLR-7d,NLPR-1d,NLPR-3d,NLPR-5d,and NLPR-7d(P<0.05).(3)Logistic regression analysis of 28-day mortality in patients with severe pneumonia: PCT-7d,NLR-5d,NLR-7d,NLPR-5d,and NLPR-7d were independent risk factors for poor prognosis of severe pneumonia.(4)The predictive value of related indicators for 28-day mortality risk of severe pneumonia: ROC analysis was performed with PCT-7d,NLR-5d,NLR-7d,NLPR-5d,and NLPR-7d as test variables.The best cut-off values of each index to predict the28-day mortality risk of patients with severe pneumonia were 0.49ng/ml,11.5,14.77,6.49,and 6.16,respectively,and the AUC values were 0.859,0.813,0.800,0.799,and0.801,respectively.Conclusion:(1)Dynamic monitoring and analysis of PCT,NLR and NLPR have certain clinical value in predicting the prognosis of severe pneumonia.(2)PCT-7d,NLR-5d,NLR-7d,NLPR-5d,and NLPR-7d were independent risk factors for poor prognosis in patients with severe pneumonia.