Predictive Value Of Dynamic Of Neutrophil/lymphocyte Ratio And Platelet Indicators For The Severity And Prognosis Of Patients With Sepsis

Objective :To explore the predictive value of neutrophil / lymphocyte ratio(NLR)and platelet indicators for the severity of septic patients.And explore the predictive value of dynamic detection of NLR and platelet indicators for the prognosis of patients with sepsis.Methods:This study is a single center and retrospective observation.We enrolled in the emergency intensive care unit(EICU)of Lianyungang Hospital of Traditional Chinese Medicine from February to October 2017,who were eligible for inclusion criteria.The patients were divided into sepsis group and septic shock group according to the diagnostic criteria,they were divided into survival group and death group according to the the 28 day mortality.Collect the general data of patients and the first,third,fifth day laboratory indicators(Day1,3,5: white blood cell count(WBC),neutrophil count(Neu),lymphocyte count(Lym),platelet count(PLT),mean platelet volume(MPV)and conventional laboratory indicators),calculate the Day1 APACHE score,Day1 and Day5 SOFA score.(1)Compared the general data and laboratory indicators of Day1 in sepsis group and septic shock group,and drew the receiver-operating characteristic curve(ROC)for research indicators,and evaluated the predictive value of research indicators for septic shock.(2)Compare the laboratory indicators of Day1,3 and 5 in survival group and death group.Analyze the trend of research indicators in the two groups.Araw the ROC for research indicators,compare the area under the curve(AUC)of Day1,3,5;and evaluation of the predictive value of research indicators on 28 day mortality in patients with sepsis.Analysis of the correlation between the research indicators and SOFA scoreResults: 1.A total of 61 patients were included in this study,including sepsis patients 34 cases(55.7%),septic shock patients 27 cases(44.3%).19 cases(31.15%)of these patients died and 42 cases(68.85%)survival in 28 days,in sepsis group 7 cases weredied(20.6% mortality),in septic shock group 12 cases were died(44.4% mortality).2,The median of Age in septic shock group was 77 years old,the mortality was 44.4%,which was higher than that in sepsis group(P<0.05).The APACHE II scores,SOFA scores,NLR and MPV/PLT in septic shock group were higher than those in sepsis group(P<0.01)on the 1st day,while Lym,PLT in septic shock group were lower than those in sepsis group.The ROC showed that the AUC of APACHE II,SOFA,NLR,MPV/PLT and PLT in predicting septic shock were 0.906,0.920,0.771,0.710,0.707,with the best cut-off values were 19.5,20.59,0.094,128*10^9/L,respectively.3,Prognosis: Day1:APACHEII score,SOFA score in death group were higher than those in survival group(P<0.01).Day3:NLR,MPV and MPV/PLT in death group were higher than those in survival group(P<0.05 or P<0.01).Lym and PLT were lower than those in survival group(P<0.05 or P<0.01).Day5:The SOFA score,WBC,Neu,NLR,MPV and MPV/PLT in death group were higher than those in survival group(P<0.05 or P<0.01),Lym and PLT were lower than those in survival group(P<0.01).In the first 5 days after admission,in death group : NLR,MPV and MPV/PLT showed an upward trend,PLT showed a downward trend.While in survival group : NLR showed a downward trend,PLT first decreased and then increased,MPV and MPV/PLT first increased and then decreased.Receiver operating characteristic curve was drawn for evaluating the value of research indicators on the 28-day prognosis.The results showed that the AUC of NLR,PLT,MPV and MPV/PLT on the 3st day were 0.799,0.663,0.707,0.690,respectively;and the AUC of NLR,PLT,MPV and MPV/PLT on 5st day were0.941,0.801,0.798 and 0.822,respectively.The maximum AUC of research indicators were at the 5st day.Base on NLR > 17.6 on the 5th day as a predictor of cut-off value of death in 28 days,the sensitivity was 84.2%,specificity was 90.4%;when PLT < 83*10^9/L on the 5th day as a predictor of cut-off value,the sensitivity was 52.6%,specificity was97.6%;when MPV > 11.1fl on the 5th day as a predictor of cut-off,the sensitivity was94.7%,specificity was 54.7%;when MPV/PLT > 0.142 on the 5th day as a predictor of cut-off,the sensitivity was 57.8%,specificity was 92.8%.The AUC of NLR was larger than that of PLT and MPV(P<0.05)on the 5th day.Correlation analysis showed that NLR,MPV and MPV/PLT were positively correlated with SOFA scores in patients with sepsis on the 5th day,and PLT was negatively correlated with SOFA scores on the 5th day.Conclusion:1.NLR,PLT and MPV/PLT are associated with the severity of sepsis.These indicators can evaluate the severity of septic patients.2.NLR,PLT,MPV,and MPV/PLT are associated with the prognosis of patients with sepsis.3.The NLR,PLT,MPV and MPV/PLT at 5st day were one of the important indicators for predicting 28-day mortality of patients with sepsis,and these indicators were correlated with SOFA score,NLR and MPV/PLT may have better predictive value.