新生儿呼吸窘迫综合征合并呼吸机相关肺炎患儿预后影响因素及生存预测

Correlation between PLR, ELR, RAR and prognosis in newborns with respiratory distress syndrome complicated by ventilator-associated pneumonia

摘要

目的 探究新生儿呼吸窘迫综合征(RDS)合并呼吸机相关肺炎(VAP)患儿在血小板/淋巴细胞比率(PLR)、嗜酸性粒细胞/淋巴细胞比值(ELR)和红细胞分布宽度/白蛋白比值(RAR)水平的变化与其对预后的影响,并评估其联合预测的能力。方法 选取2021年8月至2023年8月于河北北方学院附属第一医院收治的120例患RDS的新生儿为研究对象,根据是否发生VAP分为VAP组22例和非VAP组98例,根据病情严重程度VAP组进一步分为低危组7例、中危组8例和高危组7例.对VAP组患儿进行28天预后状况随访,根据随访结果分为生存组16例和死亡组6例.使用全自动血液分析仪进行血常规检测,计算出PLR、ELR、RAR水平.采用多因素Logistic回归分析RDS并发VAP患儿预后的影响因素.应用受试者工作特征(ROC)曲线分析RDS并发VAP新生儿PLR、ELR、RAR水平与预后的关系。结果 与非VAP组相比,VAP组患儿中PLR、ELR、RAR水平显著升高(t=5.580、7.970、11.603,P<0.05).与低危组相比,高危组患儿中PLR水平显著升高(F=5.950,P<0.05).与低危组相比,中危组和高危组患儿中ELR、RAR水平依次显著升高(F=14.788、20.248,P<0.05).与生存组相比,死亡组PLR(t=3.501,P=0.002)、ELR(t=5.502,P<0.05)、RAR(t=3.646,P=0.002)水平显著升高.PLR[OR=2.744(1.772~4.248)]、ELR[OR=3.285(1.714~6.297)]、RAR[OR=1.894(1.485~2.415)]水平为RDS并发VAP患儿预后的危险因素(P<0.05).与PLR、ELR、RAR单独预测相比,三者联合预测RDS并发VAP新生儿预后的曲线下面积(AUC)0.917(95%CI:0.718~0.991)显著升高(Z_{PLR~PLR+ELR+RAR}=3.575,P<0.001;Z_{ELR~PLR+ELR+RAR}=3.319,P<0.001;Z_{RAR~PLR+ELR+RAR}=4.582,P<0.001)。结论 RDS并发VAP新生儿PLR、ELR、RAR水平显著升高,与病情严重程度有关,是影响新生儿预后的重要因素,三者联合检测能够提高对RDS并发VAP新生儿预后的预测价值.

Abstract

Objective To explore the changes in platelet-to-lymphocyte ratio (PLR), eosinophil-to-lymphocyte ratio (ELR), and red blood cell distribution width-to-albumin ratio (RAR) in neonates with neonatal respiratory distress syndrome (RDS) complicated by ventilator-associated pneumonia (VAP) and their impact on prognosis, as well as to assess the predictive ability of these combined factors. Methods A total of 120 neonates with RDS admitted to the First Affiliated Hospital of Hebei North University from August 2021 to August 2023 were selected as the study subjects. Based on the occurrence of VAP, they were divided into the VAP group (22 cases) and the non-VAP group (98 cases). According to the severity of illness, the patients of VAP group were further divided into the low-risk group (7 cases), moderate-risk group (8 cases), and high-risk group (7 cases). The VAP group was followed up for 28 days for prognosis, with the follow-up results divided into the survival group (16 cases) and the death group (6 cases). Blood routine tests were performed using an automatic blood analyzer to calculate the levels of PLR, ELR, and RAR. Multivariate logistic regression was used to analyze the prognostic factors of RDS complicated by VAP. Receiver operating characteristic (ROC) curves were applied to analyze the relationship between PLR, ELR, and RAR levels and prognosis in neonates with RDS complicated by VAP. Results Compared with the non-VAP group, the levels of PLR, ELR, and RAR in the VAP group were significantly higher (t=5.580, 7.970 and 11.603, respectively, P<0.05). Compared with the low-risk group, the PLR level was significantly higher in the high-risk group (F=5.950, P<0.05). Compared with the low-risk group, the ELR and RAR levels were significantly higher in the moderate-risk and high-risk groups (F=14.788 and 20.248, respectively, P<0.05). Compared with the survival group, PLR (t=3.501, P=0.002), ELR (t=5.502, P<0.05) and RAR (t=3.646, P=0.002) levels in the death group were significantly increased. PLR [OR=2.744 (1.772-4.248)], ELR [OR=3.285 (1.714-6.297)], RAR [OR=1.894 (1.485-2.415)] levels were the prognoses of RDS complicated with VAP (P<0.05). Compared with individual prediction of PLR, ELR and RAR, the combined prediction of these three factors significantly increased the area under the curve (AUC) for predicting prognosis in neonates with RDS complicated by VAP (95%CI: 0.718-0.991) (Z_{PLR~PLR+ELR+RAR}=3.575, P<0.001; Z_{ELR~PLR+ELR+RAR}=3.319, P<0.001; Z_{RAR~PLR+ELR+RAR}=4.582, P<0.001). Conclusion The levels of PLR, ELR, and RAR are significantly increased in neonates with RDS complicated by VAP and are associated with the severity of illness. These factors are important predictors of prognosis in neonates, and their combined detection can improve the predictive value for prognosis in RDS complicated by VAP.

关键词

呼吸窘迫综合征 / 呼吸机相关性肺炎 / 新生儿 / 血小板/淋巴细胞比率 / 嗜酸性粒细胞/淋巴细胞比值 / 红细胞分布宽度/白蛋白比值 / 预后

Key words

respiratory distress syndrome / ventilator-associated pneumonia / neonate / platelet/lymphocyte ratio / eosinophil/lymphocyte ratio / red blood cell distribution width/albumin ratio / prognosis

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基金资助

张家口市科学技术局科技计划项目(2121187D)