The Prognostic Value Of NLR,ACAG And 24h LCR In Patients With Septic Shock

Objective:To evaluate the prognostic value of neutrophil to lymphocyte ratio（NLR）,albumin-corrected anion gap（ACAG）and 24h lactic acid clearance（24h LCR）in patients with septic shock.To investigate the prognostic value of NLR,ACAG and 24h LCR in patients with septic shock at different sites of infection.To evaluate the correlation between NLR,ACAG,24h LCR and APACHEⅡscore,in order to provide a theoretical basis for the prognosis assessment of septic shock patients.Methods:Patients with septic shock admitted to the Emergency Intensive care Unit（EICU）of Xinjiang Uygur Autonomous Region People’s Hospital from October 2020 to March 2022 were selected as subjects in a retrospective study.The diagnostic criteria for septic shock were based on the diagnostic criteria for septic shock defined in the International Guidelines for the Treatment of Sepsis and Septic Shock（2021 Edition）^[1].A total of 113 patients diagnosed with septic shock were divided into a survival group of 55 patients and a death group of 58 patients according to their prognosis at 28 days.The patients were divided into lung infection group（68 cases）and other site infection group（45 cases）.To collect relevant indicators when patients were admitted to the ICU,Including basic data,basic medical history,vital signs,site of infection,laboratory indicators（blood routine,serum ions,liver function,kidney function,immediate blood lactic acid after admission to the ICU,lactic acid after 24 hours of admission to the ICU）,sequential organ failure（SOFA）score,acute physiology and chronic health status（APACHEⅡ）score,28d follow-up.Neutrophil/lymphocyte ratio（NLR）,albumin-corrected anion gap（ACAG）and 24h lactic acid clearance（24h LCR）were calculated.Univariate analysis was performed on the above collected basic data and laboratory indicators,and then multivariate Logistic regression equation was used to further process the statistical difference indicators,and the risk factors affecting the prognosis of septic shock were calculated.ROC curve was plotted to evaluate the prognostic value of NLR,ACAG and 24h LCR alone and in combination.Spearman test was used to analyze the correlation between NLR,ACAG,24h LCR and APACHEⅡscores.Results:（1）There were 58 patients in the death group and 55 patients in the survival group.The NLR of the two groups was15.25（9.77,23.72）vs 7.82（5.50,14.14）,respectively,and the difference was statistically significant（P<0.05）.ACAG in 2 groups was 22.41±6.36vs18.06±4.62,the difference was statistically significant（P<0.05）.24h LCR of 2 groups were 14.02（-16.10,41.30）vs42.00（11.00,62.29）,and the difference was statistically significant（P<0.05）.（2）68 patients with septic shock caused by pulmonary infection,37 died and 31survived.The NLR of the two groups was 16.59（11.94,27.33）vs8.66（5.95,17.09）,respectively,and the difference was statistically significant（P<0.05）.ACAG in 2 groups was 21.82±6.45vs17.53±4.68,the difference was statistically significant（P<0.05）.24h LCR of 2 groups were 9.18（-20.15,32.6）vs43.5（13.64,65.43）,respectively,and the difference was statistically significant（P<0.05）.45 patients with septic shock caused by other sites,21 died and 24 survived.The NLR of the two groups were11.23（9.04,17.37）vs7.58（5.00,10.75）,respectively,and the difference was statistically significant（P<0.05）.ACAG in 2 groups was 23.46±6.22vs18.75±4.55,the difference was statistically significant（P<0.05）.24h LCR of 2 groups were 28.62（-7.27,46.39）vs35.74（9.23,62.02）,respectively,with no statistical significance（P>0.05）.（3）Binary logistic regression analysis showed that APACHEⅡ score（OR=1.198,P<0.05）,NLR（OR=1.064,P<0.05）,ACAG（OR=1.226,P<0.05）were risk factors for death in septic shock patients.24h LCR（OR=0.978,P<0.05）was a protective factor for death in septic shock patients.（4）The AUC of APACHE II score was 0.783,and the sensitivity and specificity were 75.9%and 76.4%when the cut-off value was 21.5.The AUC of NLR is0.746.When the cut-off value is 9.165,the sensitivity is 84.5%and the specificity is 61.8%.The AUC of ACAG was 0.701,and the sensitivity and specificity were 74.1%and 56.4%when the cut-off value was 18.105mmol/L.The AUC of 24h LCR was 0.712,and the sensitivity and specificity were 93.1%and 43.6%when the cut-off value was 18.105mmol/L.The AUC of NLR+ACAG+24h LCR was 0.834,the sensitivity was 84.5%,and the specificity was 75.5%.（5）There is a positive correlation between NLR and APACHEⅡ score（r>0,P<0.05）,24h LCR was negatively correlated with APACHEⅡ score（r<0,P<0.05）,the correlation between ACAG and APACHEⅡ score was not statistically significant（P>0.05）.Conclusions:1.NLR,ACAG and 24h LCR have certain clinical value in prognostic evaluation of septic shock patients.2.APACHEⅡ score,NLR and ACAG are risk factors affecting death,while 24h LCR is protective factor affecting death.3.The accuracy of the combined detection of NLR+ACAG+24h LCR in predicting the mortality of septic shock is better than that of a single index,and the combined detection effect is better.4.There is correlation between NLR and 24h LCR and APACHEⅡ score,while there is no obvious correlation between ACAG and APACHEⅡ score.