外周血平均血小板体积/淋巴细胞计数(MPVLR)联合APACHE II评分对脓毒症患者预后的预测价值

The Prognostic Value of the Mean Platelet Volume-to-Lymphocyte Ratio Combined (MPVLR) with the APACHE II Score in Predicting the Outcomes of Patients with Sepsis

摘要: 目的：探讨外周血平均血小板体积/淋巴细胞计数(MPVLR)联合APACHE II评分对脓毒症患者预后的预测价值。方法：采用回顾性队列研究方法，选择该院2020年8月至2023年8月收治的符合脓毒症3.0诊断标准的患者。根据脓毒症患者的28 d预后情况分为生存组及死亡组。收集患者的临床资料及确诊脓毒症后24 h内血小板体积(MPV)、淋巴细胞(LYM)计数的最差值，并计算平均血小板体积/淋巴细胞计数(MPVLR)、APACHE II评分及SOFA评分。随后使用多因素Logistic回归分析，确定脓毒症患者预后的影响因素，再构建受试者工作特征曲线，评估各项指标对脓毒症患者预后的预测价值。结果：共纳入患者127例，生存组患者76例，死亡组患者51例。死亡组患者更易合并慢性阻塞性肺疾病，且平均血小板体积(MPV)、平均血小板体积/淋巴细胞计数(MPVLR)、APACHE II评分、SOFA评分、及年龄均高于生存组，且差异具有统计学意义(P < 0.05)。而生存组的外周血淋巴细胞计数均高于死亡组，差异具有统计学意义(P < 0.05)。由多因素Logistic回归分析可知，MPVLR、APACHE II评分是预测脓毒症患者28d死亡的独立危险因素(P < 0.05)。根据ROC曲线结果可知，MPVLR、APACHE II评分及MPVLR联合APACHE II评分的AUC分别为0.840、0.800、0.885。因此，当MPVLR联合APACHE II评分的AUC为0.824时，灵敏度及特异度分别为94.6、82.4%，此时对脓毒症患者预后的预测价值最佳。结论：APACHE II评分、MPVLR是脓毒症患者28d死亡的独立危险因素，且二者联合时对脓毒症患者预后的预测价值更高。

Abstract: Objective: To investigate the prognostic value of the mean platelet volume (MPV)-to-lymphocyte ratio (MPVLR) combined with the APACHE II score in predicting the outcomes of patients with sepsis. Methods: This retrospective study screened patients with sepsis who were hospitalized in our hospital, from August 2020 to August 2023 were included and categorized into the survival group and the non-survival group based on 28-day outcomes of sepsis patients. Clinical date and the worst of mean platelet volume (MPV), lymphocyte (LYM) count values within 24 hours of sepsis diagnosis were collected, MPVLR and APACHE II scores were calculated. Multifactorial logistic regression analysis was used to identify risk factors affecting the prognosis of sepsis patients, and then a subject operating characteristic curve (ROC) was constructed to assess the predictive value of each indicator on the prognosis of sepsis patients. Results: A total of 127 patients were included, with 76 in the survival group and 51 in the non-survival group. Patients in the non-survival group were more likely to have chronic obstructive pulmonary disease, and had significantly higher MPV, MPVLR, APACHE II scores, SOFA scores and age compared to the survival group (P < 0.05). In contrast, peripheral blood lymphocyte counts in the survival group were significantly higher than that in the non-survival group (P < 0.05). Multivariate logistic regression analysis showed that MPVLR and APACHE II scores were independent risk factors for 28-day mortality in sepsis patients (P < 0.05). Receiver operating characteristic curve (ROC) curve analysis showed that the area under the curve (AUC) values for MPVLR, APACHE II scores, and their combination were 0.840, 0.800, and 0.885, respectively. Notably, the MPVLR combined with the APACHE II score showed the best predictive value, with an AUC of 0.824. It demonstrated excellent predictive performance, achieving a sensitivity of 94.6% and a specificity of 82.4%. Conclusion: APACHE II scores and MPVLR are independent risk factors for 28-day mortality in sepsis patients, and their combined use provides higher predictive value.