基于血常规的衍生指标联合SAPSⅡ评分对老年脓毒症相关急性肾损伤患者的预后价值分析

doi:10.3969/j.issn.1003-9198.2025.12.015

摘要/Abstract

摘要： 目的探究中性粒细胞-淋巴细胞比值(NLR)、淋巴细胞-单核细胞比值(LMR)、血小板-淋巴细胞比值(PLR)、红细胞分布宽度-血小板计数比值(RPR)联合简化急性生理学评分(SAPSⅡ)对老年脓毒症相关急性肾损伤(SA-AKI)患者90 d预后的预测价值。方法基于重症监护医疗信息库(MIMIC)-Ⅳ 2.2版数据库,回顾性分析2008—2019年首次入住ICU的4589例老年SA-AKI患者的病例资料,根据90 d预后分为存活组(2978例)和死亡组(1611例)。采用单因素和多因素Cox回归分析筛选老年SA-AKI 患者预后的独立危险因素。通过ROC曲线的AUC评估各指标及联合模型对老年SA-AKI患者90 d预后的预测效能。结果多因素Cox回归分析结果显示,NLR、LMR、RPR、24 h尿量、乳酸、尿素氮、SAPSⅡ是老年SA-AKI患者90 d死亡的独立危险因素(P<0.05)。ROC曲线分析结果显示,NLR+LMR+RPR联合SAPSⅡ预测老年SA-AKI患者90 d预后的AUC为0.717(95%CI:0.701～0.733),高于尿素氮+24 h尿量联合SAPSⅡ的AUC[0.692(95%CI:0.676～0.709)](DeLong’s检验,P<0.001)。结论血常规衍生指标(NLR、LMR、RPR)联合SAPSⅡ对SA-AKI患者的90 d预后具有较好的预测价值,其效能优于传统肾损伤指标联合SAPSⅡ。

Abstract: Objective To investigate the predictive value of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width-to-platelet ratio (RPR) combined with simplified acute physiology score Ⅱ (SAPS Ⅱ)for the 90-day prognosis of elderly patients with sepsis-associated acute kidney injury (SA-AKI). Methods Based on the MIMIC-Ⅳ 2.2 database, a retrospective analysis was conducted on 4589 elderly SA-AKI patients admitted to the ICU for the first time from 2008 to 2019. According to their 90-day outcome, the patients were divided into a survival group (n=2978) and a death group (n=1611). Univariate and multivariate Cox regression analysis were used to identify independent risk factors for prognosis. The predictive performance of each indicator and combined models for the 90-day prognosis was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Results Multivariate Cox regression analysis showed that NLR, LMR, RPR, 24-hour urine output, lactate, blood urea nitrogen (BUN), and the SAPS Ⅱ were independent risk factors for 90-day mortality in elderly SA-AKI patients (P<0.05). ROC curve analysis revealed that the combined model of NLR+LMR+RPR+SAPS Ⅱ had an AUC of 0.717 (95%CI: 0.701-0.733) for predicting 90-day prognosis, which was significantly higher than the AUC of 0.692 (95%CI: 0.676-0.709) for the model combining BUN+24-hour urine output+SAPS Ⅱ (DeLong’s test, P<0.001). Conclusions The combination of complete blood count-derived ratios (NLR, LMR, RPR) and SAPS Ⅱ has good predictive value for the 90-day prognosis of SA-AKI patients, outperforming the model combining traditional kidney injury markers and SAPS Ⅱ.

Key words: sepsis-associated acute kidney injury, aged, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, red blood cell distribution width-to-platelet count ratio, prognosis, MIMIC-Ⅳ database, simplified acute physiology score

中图分类号:

蔡洪霞, 张晓敏, 周耀, 张心北, 邹良哲, 高志梅, 屠苏. 基于血常规的衍生指标联合SAPSⅡ评分对老年脓毒症相关急性肾损伤患者的预后价值分析[J]. 实用老年医学, 2025, 39(12): 1263-1268.

CAI Hongxia, ZHANG Xiaomin, ZHOU Yao, ZHANG Xinbei, ZOU Liangzhe, GAO Zhimei, TU Su. Prognostic value of complete blood count-derived ratios combined with the SAPS Ⅱ Score in elderly patients with sepsis-associated acute kidney injury[J]. Practical Geriatrics, 2025, 39(12): 1263-1268.

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