RESUMEN
Objective To explore the evaluation value of dynamic monitoring of neutrophil/lymphocyte ratio(NLR)in severity of illness and prognosis of bacterial sepsis.Methods Clinical data and laboratory index of 72 cases of patients with bacterial sepsis in ICU of Yangpu Hospital Affiliated to Tongji University were retrospectively analyzed.According to the severity of illness,patients were divided into sepsis group(n=20),severe sepsis group(n=30)and septic shock group(n=22).According to the mortality within 28 d,patients were divided into survival group(n=47),death group(n=25).The 0 h NLR,48 h NLR and change rate of NLR between two groups were compared,and the influence factors of prognosis were analyzed.Results With the increase of severity of illness,the time of mechanical ventilation was shortened((8.8±1.9)d,(4.6±0.6)d,(3.9±0.4)d),and PLT((146.4±45.8)×109/L,(110.6±41.3)×109/L,(102.5±38.6)×109/L),NLR rate(0.61±0.26,0.26±0.11,0.22±0.09)were decreased significantly,APEACHE Ⅱ score,CRP,PCT,0 h NLR,48 h NLR were increased obviously((18.5±2.3)points,(20.4±3.6)points,(23.1±3.9)points;(72.6±10.4)mg/L,(78.2±11.6)mg/L,(85.2±12.5)mg/L;(1.5±0.4)μg/L,(2.3±0.6)μg/L,(2.7±0.9)μg/L;11.3±2.6,14.2±3.4,15.7±3.5;3.4±0.9,9.7±2.4,11.2±2.6),the differences were statistically significant(P＜0.05).Compared with death group,the time of mechanical ventilation in survival group was prolonged((4.1±0.3)d vs.(8.7±1.4)d),APEACHE Ⅱ score,CRP,PCT,0 h NLR,48 h NLR were decreased obviously((21.4±3.5)points vs.(18.3±2.6)points,(78.2±11.6)mg/L vs.(71.5±10.8)mg/L,(2.5±0.7)μg/L vs.(1.4±0.6)μg/L,(15.0±3.3)vs.(11.6±2.4),(10.5±2.8)vs.(3.2±0.8)),and PLT,NLR rate were increased significantly((106.5±41.5)×109/L vs.(148.4±50.8)×109/L,0.24±0.10 vs.0.65±0.24),the differences were statistically significant(t=16.18,4.26,2.44,6.99,5.01,16.73,3.54,8.15,P＜0.05).Multivariate logistic regression analysis showed that APEACHE Ⅱ score,0 h NLR were the independent risk factors of death in patients with bacterial sepsis(OR=3.99,3.01,95％CI:1.65-2.38,1.99-4.54,P＜0.05),and NLR rate was independent protection factor(OR=0.95,95％CI:0.91-0.97,P＜0.05).Conclusion Dynamic monitoring of peripheral blood NLR can help to judge the prognosis and severity of illness of patients with bacterial sepsis,and NLR before treatment and change rate of NLR are an independent predictors of death.
RESUMEN
Objective To investigate the clinical significance of serun procalcitonin (PCT) and adrenomedullin(ADM) levels in elderly patients with pneumonia diagnosis.Methods Thirty-eight elderly patients with pneumonia who were admitted to our hospital were collected as the study group.Thirty-two cases of non-pneumonic patients hospitalized in respiratory department at the same period for lung tumor,non-infective interstitial lung diseases and pulmonary edema were chosen as the control group.According to CURB-65 score,the study group was divided into three subgroups as mild,moderate and severe group.Levels of serum PCT and ADM at the 1st day,3rd day and 7th day were measured by ELISA,and data were statistically analyzed.Results Serum PCT ((1.98 ± 0.32) μg/L vs.(1.63 ± 0.44) μg/L,t =3.989,P =0.040) and ADM levels ((0.92±0.31) μg/L vs.(0.52±0.12) μg/L,t =5.987,P ＜0.001) on the first day of the treatment was significantly higher than in the control group.Serum PCT and ADM levels in the three subgroups decreased after treatment,and at each time point serum PCT (1st day:(2.19 ±:0.36) μg/L vs.(1.80 ± 0.28) μg/L vs.(1.83 ±0.22) μg/L;3rd day:(2.08 ±0.34) μg/L vs.(1.73 ±0.35) μg/L vs.(1.75 ±0.24) μg/L;7th day:(2.05 ±0.32) μg/L vs.(1.65 ±0.30) μg/L vs.(1.61 ±0.31) μg/L) and ADM levels (1st day:(1.08 ± 0.31) μg/L vs.(0.80 ± 0.25) μg/L vs.(0.77 ± 0.22) μg/L; 3rd day:(1.09 ± 0.32) μg/L vs.(0.77 ±0.23) μg/L vs.(0.75 ±0.21) μg/L;7th day:(1.08 ±0.33) μg/L vs.(0.66 ±0.18) μg/L vs.(0.72 ±0.25) μg/L) in the severe group were significantly higher than in the other two subgroups (P ＜0.05).Serum PCT and ADM levels in survived patients on the 1 st day,3rd day,and 7th day after treatment were significantly lower than in patients who were deceased (PCT:1 st day:(1.82 ± 0.26) μg/L vs.(2.16 ± 0.37)μg/L;3rd day:(1.74 ± 0.29) ~L vs.(2.06 ±0.31) μg/L;7th day:(1.62 ± 0.30) μg/L vs.(2.03 ±0.30) μg/L;P ＜0.05 ;ADM:1st day:(0.78 ± 0.23) μg/L vs.(1.06 ± 0.29) μg/L;3rd day:(076 ± 0.21)μg/L vs.(1.08 ± 0.30) μg/L; 7 th day:(0.70 ± 0.20) μg/L vs.(1.09 ± 0.35) μg/L; P ＜ 0.05),and serum PCT and ADM levels did not change significantly in deceased patients after treatment.Conclusion Serum PCT and ADM levels can serve as serum markers in early diagnosis,the severity of pneumonia and estimating prognosis in elderly patients.