中性粒细胞百分比与高龄感染患者死亡率相关性分析

Correlation between neutrophil percentage and mortality of very old infected patients

摘要:

目的 探讨中性粒细胞百分比与高龄感染患者死亡率的相关性并评价其应用价值。方法 以2013年1月至2017年6月空军军医大学西京医院老年病科住院治疗的191例高龄感染患者为研究对象,按30 d是否死亡将其分为死亡组(A组)和未死亡组(B组)；研究两组患者中性粒细胞百分比(NP)＞90%、临床相关指标、合并症与30 d死亡率的关系。采用SPSS 18.0统计软件进行数据分析,根据数据类型,组间比较采用t检验或χ²检验；单因素相关分析采用Spearman相关分析,多因素相关分析采用logistic回归法。结果 两组年龄、性别、合并症、白细胞(WBC)差异无统计学意义(P＞0.05)；A组NP＞90%患者比例、脓毒症比例、高敏C-反应蛋白(hs-CRP)、血乳酸、降钙素原(PCT)、急性生理与慢性健康评分(APACHE)Ⅱ、序贯性器官衰竭评估评分(SOFA)、机械通气及留置导尿比例较B组均显著升高,差异有统计学意义(P＜0.05)。Spearman单因素相关分析显示,患者30 d死亡率与NP>90%(r=0.223)、APACHE Ⅱ评分(r=0.156)、SOFA评分(r=0.316)、血乳酸(r=0.453)、hs-CRP(r=0.656)、PCT(r=0.121)、脓毒症(r=0.286)、机械通气(r=0.461)、留置导尿比例(r=0.112)呈正相关。多因素logistic回归分析表明,NP>90%、血乳酸、hs-CRP、PCT、脓毒血症是影响30 d死亡率的独立危险因素。结论 高龄感染患者NP>90%提示其30 d死亡的危险性升高,且比白细胞计数更能敏感反映感染的程度及病情。

Abstract:

Objective To investigate the correlation between the neutrophil percentage(NP) and mortality in the very old patients with infection, and evaluate its application value. Methods A total 191very old patients aged at (86.0±2.0) years with infection admitted in our department between January 2013 and June 2017 were recruited in this study. According to whether they died within 30 d, they were divided into dead group (group A, n=120) and survival group (group B, n=71).The relationship of NP>90%,clinical indicators and complications with 30-day mortality rate was analyzed. SPSS statistics 18.0 was used to perform the statistical analysis. Student’s t test or Chi-square test was employed for different data types. Spearman correlation analysis was adopted for single factor correlation, and logistic regression for multivariate correlation analysis. Results There were no significant differences in age, sex, incidence of complications and white blood cell count (WBC) between the 2 groups (P>0.05). The group A had obviously more patients with NP>90%, higher proportion of sepsis, higher levels of high sensitivity C-reactive protein(hs-CRP), blood lactic acid and procalcitonin (PCT), higher scores of acute physiology and chronic health evaluation (APACHE) Ⅱand sequential organ failure assessment (SOFA), and larger ratios of mechanical ventilation and indwelling catheterization when compared with the group B (P<0.05). Spearman univariate correlation analysis found that 30-day mortality rate was positively correlated with NP>90% (r=0.223), APACHEⅡ score (r=0.156), SOFA score (r=0.316), blood lactic acid (r=0.453), hs-CRP (r=0.656), PCT (r=0.121), sepsis (r=0.286), mechanical ventilation (r=0.461),and indwelling catheterization (r=0.112). Multivariate logistic regression analysis showed that NP>90%, blood lactic acid, hs-CRP, PCT and sepsis were independent risk factors for 30-day mortality rate. Conclusion For the very old patients with infection, NP>90% indicates higher 30-day mortality rate. NP>90% is more sensitive to the extent and condition of infection than WBC.