The Value Of RDW-CV,NLR,MPV/PLT In Evaluating The Severity And Prognosis Of Patients With Sepsis

Objective:To analyze and explore the predictive effects of Coefficients of Variation of Red Blood Cell Distribution Width(RDW-CV),Neutrophil/Lymphocyte Ratio(NLR),Mean Platelet Volume(MPV),and Platelet Count(PLT)ratio(MPV/PLT)on the condition and prognosis of patients with sepsis.Methods:This study was a single-center retrospective study,analyzing the basic clinical data of sepsis patients admitted to the Intensive care unit(ICU)of Youjiang Medical University for Nationalities Affiliated Hospital from December 2020 to December 2022.We calculated the worst Sequential organ failure score(Sequential organ failure score,SOFA)and Acute Physiology and Chronic Health Score II(APACHE II).RDW-CV,NLR and MPV/PLT values on the first,third and fifth day were calculated,respectively.(1)According to whether sepsis shock occurred at ICU admission,patients were divided into sepsis shock group and sepsis shock group;(2)Patients with sepsis were divided into survival group and death group according to their survival conditions within 28 days.The differences between the indicators in different groups of patients were compared.Multivariate Logistic regression analysis was used to assess the condition(with or without shock)and COX risk regression model was used to assess the independent risk factors of 28-day clinical outcome.RDW,NLR,and MPV/PC were used to evaluate the severity and prognosis of sepsis patients using receiver operating characteristic curve(ROC curve).Spearman method was used to analyze the correlation between RDW-CV,NLR,MPV/PLT and each index.Results:(1)A total of 112 patients with sepsis were included in this study,including 85males(75.9%)and 27 females(24.1%),with an average age of 57.2±13.78 years.The APACHE II score was 20(17,24),the SOFA score was(10.48±4.24),the length of stay in ICU was 9(6.25,14.75)days,and the duration of ventilator assisted ventilation was 133(83.25,277.75)hours;(2)The APACHE II score,SOFA score,LAC-1d,RDW-CV-1d,NLR-1d,MPV/PLT-1d in patients with septic shock were higher than those in the non septic shock group,while the LYM-1d and PLT-1d in patients with septic shock were lower than those in the non septic shock group,with a statistically significant difference(P<0.05);(3)Multivariate logistic regression analysis suggested that the SOFA score was an independent risk factor for septic shock in patients with sepsis;(4)By plotting ROC curves,the AUC areas of APACHE II scores,SOFA,RDW-CV-1d,MPV/PLT-1d,and NLR-1d are 0.774,0.822,0.613,0.645,and0.705,respectively.The largest predictive value of a single indicator for the diagnosis of septic shock is the SOFA score,with an AUC area of 0.822.The optimal cutoff value for diagnosing septic shock in patients is 9.5 points,with a sensitivity of 75% and a specificity of77.5%;(5)Compared with the survival group,The values of shock,ICU stay time,ventilator assisted ventilation time,APACHE II score,SOFA score,RDW-CV-1d,RDW-CV-3d,RDW-CV-5d,NLR-1d,NLR-5d,MPV/PLT-1d,CR-3d,CR-5d were higher in the death group.The PLT-1d of the death group was lower than that of the survival group,and the difference was statistically significant(P<0.05);(6)RDW and NLR were significantly different at different time nodes(P<0.05),while MPV/PLT was not significantly different at different time nodes(P>0.05).RDW and MPV/PLT of survival and death groups at different time nodes were not statistically significant(P>0.05),while NLR of survival and death groups at different time nodes was statistically significant(P<0.05);(7)Using multivariate COX risk regression analysis,the results showed that: ICU hospitalization time(HR=0.914,95% CI:0.845～0.988,P<0.05),ventilator assisted ventilation time(HR=1.03,95% CI: 1.001～1.005,P<0.05),and APACHE II score(HR=1.129,95% CI: 1.058～1.204,P<0.05)were independent risk factors for short-term mortality in patients with sepsis within 28 days;(8)The AUC of ICU hospitalization time,ventilator assisted ventilation time,APACHE II score,SOFA score,RDW-CV-1d,RDW-CV-3d,RDW-CV-5d,NLR-1d,NLR-5d,PLT-1d,MPV/PLT-1d were shown by plotting ROC curves as 0.638,0.773,0.798,0.647,0.635,0.637,0.639,0.71,0.649,0.614,and 0.62,respectively.APACHE II score combined with NLR-1d+RDW-CV-1d+MPV/PLT-1d has the greatest effect on predicting the 28-day mortality outcome of sepsis;(9)Spearman results showed a positive correlation between RDW-CV and APACHE II scores.NLR is positively correlated with APACHE II score,SOFA score,NEU,MPV,MPV/PLT,CR,and negatively correlated with LYM and PLT.MPV/PLT is positively correlated with APACHE II score,SOFA score,MPV,NLR,LAC,PCT,TBil,CR,and negatively correlated with PLT.Conclusion:(1)RDW-CV,NLR and MPV/PLT values were associated with the prediction of shock and poor prognosis,but were not independent risk factors.(2)The APACHE II score combined with NRL-1D + RDAD-1D +MPV/PLT-1d showed better sensitivity in evaluating survival within 28 days of sepsis.