乳酸与血细胞比容比值预测社区获得性肺炎患者住院死亡率价值优于CURB-65评分

Lactate to Hematocrit Ratio Is Superior to the CURB-65 Score in Predicting In-Hospital Mortality in Patients with Community-Acquired Pneumonia

摘要: 目的：探讨乳酸与血细胞比容比值(lactate hematocrit ratio, LHR)在预测社区获得性肺炎(Community-acquired pneumonia, CAP)患者疾病严重程度和死亡率的价值。方法：本研究为回顾性研究，纳入了2020年11月18日至2021年11月21日期间入住青岛市市立医院本部呼吸与危重症医学科、急诊病房、重症监护室并最终诊断为CAP的366例患者。收集患者临床资料、实验室检查、预后等基础资料，并计算患者的LHR。根据患者疾病程度将患者分为非重症CAP组(Non-severe CAP, NSCAP) (n = 309)和重症CAP组(Severe CAP, SCAP) (n = 57)。根据住院期间是否发生死亡将患者分为生存组(n = 349)和死亡组(n = 17)。绘制受试者工作特征(ROC)曲线，计算曲线下面积(AUC)，比较LHR预测疾病严重程度及住院死亡率的能力。采用Cox比例风险回归分析确定LHR是否是CAP患者住院期间死亡的独立危险因素。结果：SCAP组患者LHR水平明显高于NSCAP组；LHR预测SCAP发生的AUC为0.728，明显优于单一的乳酸和血细胞比容。死亡组患者的LHR水平明显高于存活组患者；LHR > 0.061和PSI评分是CAP患者住院死亡率的独立危险因素；LHR预测CAP患者住院死亡率优于CURB-65评分；Kaplan-Meier生存曲线显示LHR < 0.061的CAP患者在30天内的生存率显著高于LHR ≥ 0.061的CAP患者。结论：LHR与CAP的严重程度相关，其预测SCAP的能力明显优于单一的乳酸；LHR预测CAP住院死亡率方面优于CURB-65评分，可作为评估CAP患者预后的新指标。

Abstract: Purpose: To investigate the value of lactate-to-hematocrit ratio (LHR) in predicting disease severity and mortality in patients with community-acquired pneumonia (CAP). Methods: This retrospective study included 366 CAP patients diagnosed with CAP who were admitted to the Department of Respiratory and Critical Care Medicine, Emergency Ward, and Intensive Care Unit at the Qingdao Municipal Hospital from November 18, 2020, to November 21, 2021. Clinical data, laboratory tests, and prognostic information were collected from the patients, and the LHR was calculated for each individual. Based on the severity of the disease, patients were categorized into a non-severe CAP group (NSCAP) (n = 309) and a severe CAP group (SCAP) (n = 57). Additionally, patients were divided into a survival group (n = 349) and a death group (n = 17) according to whether mortality occurred during hospitalization. Drawing the Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) was calculated to compare the ability of the LHR in predicting disease severity and in-hospital mortality. Cox proportional hazards regression analysis was used to determine whether LHR is an independent risk factor for in-hospital mortality in CAP patients. Results: The LHR level in SCAP group was significantly higher than that in NSCAP group; the AUC of LHR for predicting SCAP was 0.728, significantly better than that of single lactate and hematocrit. The LHR level in the death group was significantly higher than that in the survival group; LHR > 0.061 and PSI score were independent risk factors for in-hospital mortality in CAP patients; LHR was superior to CURB-65 score in predicting in-hospital mortality in CAP patients; Kaplan-Meier survival curve demonstrated that CAP patients with an LHR < 0.06 had a significantly higher 30-day survival rate compared to those with an LHR ≥ 0.061. Conclusion: LHR is associated with the severity of CAP, and its ability to predict SCAP is significantly better than that of single lactate; LHR is superior to CURB-65 score in predicting in-hospital mortality in CAP patients and can be used as a new indicator for assessing the prognosis of patients with CAP.