Clinical study on neutrophil to lymphocyte ratio and neutrophil extracellular traps with liver injury in patients with sepsis / 中华急诊医学杂志

ABSTRACT

Objective:To explore the clinical value of peripheral blood neutrophil-to-lymphocyte ratio (NLR) combined with neutrophil extracellular traps (NETs) in predicting liver injury in patients with sepsis.Methods:A prospective observational study was conducted. The patients who met the diagnostic criteria for sepsis 3.0 admitted to the Department of Intensive Care Unit in Wuxi People’s Hospital Affiliated to Nanjing Medical University from March 2019 to June 2020 were selected as the research objects. The basic informations of the patients were recorded. NLR based on blood routine at admission was calculated. PicoGreen fluorescence quantitative detection kit was used to detect the quantitative level of free DNA (cf-DNA/NETs) in the peripheral plasma of patients at admission. According to whether liver injury occurred, the patients were divided into the sepsis without liver injury group and sepsis with liver injury group. Binary Logistics regression analysis was used to predict the risk factors of sepsis with liver injury. The receiver operating characteristic (ROC) curve was drawn. The value of NLR, NETs, NLR combined with NETs in predicting liver injury in patients with sepsis was analyzed.Results:A total of 122 patients with sepsis were enrolled, of which 45 patients suffered from septic liver injury, with an incidence rate of 36.89%. The NLR of the sepsis wth liver injury group was (21.63 ± 4.71), the NLR of the sepsis without injury injury group was (15.03 ± 4.71), and the NETs level of the sepsis with liver injury group was (505.86 ± 250.05) μg/L, the level of NETs in the sepsis without liver injury group was (179.27 ± 67.20) μg/L, and the differences between the two groups were statistically significant (all P<0.05). Binary logistic regression analysis found that NLR ( OR=1.470, 95% CI 1.121-1.926, P<0.05) and NETs ( OR=1.018, 95% CI 1.005-1.030, P<0.05) at admission were the independent risk factors for liver injury in patients with sepsis. The best cut-off value of NLR was 16.68, and the best cut-off value of NETs was 317 μg/L. The sensitivity of combined application of NLR and NETs to predict liver injury in patients with sepsis was 77.78%, specificity was 98.70%, the area under the curve was 0.930, and the Youden Index was 0.765. Conclusions:The peripheral blood NLR and NETs levels are independent risk factors for liver injury in patients with sepsis. The combined application of NLR and NETs has a certain predictive value for liver injury in patients with sepsis. Taking NLR of 16.68 and NETs of 317 μg/L as the cut-off values, they can be used as early warning indicators to predict liver injury in patients with sepsis.