Clinical study of leukocyte-to-platelet ratio in early evaluating prognosis of sepsis

doi:10.16138/j.1673-6087.2022.03.007

Abstract

Abstract:

Objective To investigate the clinical value of white blood cell-to-platelet (WBC/PLT) ratio and related factors in early prognosis evaluation of sepsis. Methods The clinical data of 150 patients diagnosed with sepsis admitted to the emergency intensive care unit (EICU) in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from June 2018 to June 2020 were prospectively analyzed. According to survival or death, the patients were divided into survival group(n=126) and death group(n=24). The difference of WBC/PLT and clinical and biochemical indexes between two groups in 24 h after onset of sepsis were compared, and the Pearson correlation was used to analyze the correlation between WBC/PLT ratio and risk factors in the patients with sepsis. The Cox regression model was used to evaluate the clinical predictive value of various factors on mortality, and the receiver operating characteristic(ROC) curve was applied to analyze the predictive effect of WBC/PLT ratio on prognosis in the patients with sepsis. Result There was no significant difference in age, gender, infection type and constituent ratio of underlying diseases between the survival or death groups (P>0.05). The proportion of septic shock patients, receiving vasoactive medicines, mechanical ventilation and blood purification in the death group were significantly higher than those in the survival group(P<0.05). The levels of procalcitonin (PCT), urea nitrogen, aspartate aminotransferase (AST), prothrombin time (PT), fibrinogen degradation product （FDP）, D-dimer, pro-brain natriuretic peptide（pro-BNP）and sequential organ failure assessment(SOFA) scores in the death group were significantly higher than those in the survival group. The ratio of WBC/PLT in death group (0.56±1.27) was significantly higher than that in survival group(0.15±0.42)(P<0.05). The Pearson correlation analysis showed that the ratio of WBC/PLT was positively correlated with C-reaction protein(CRP), PCT, urea nitrogen, creatinine, pro-BNP, FDP, and D-dimer(P<0.05). The Cox regression model analysis presented that high WBC/PLT ratio, high urea nitrogen level and high SOFA score were independent risk factors for prognosis in the patients with sepsis (P<0.05). The area under ROC curve of WBC/PLT ratio was 0.643(95% CI: 0.516-0.770, P=0.026), and an optimal cut-off value was 0.186, with sensitivity of 37.5% and specificity of 91.3%. Conclusions The WBC/PLT ratio shows high specificity in the prognosis evaluation of sepsis, which can predict the prognosis of patients early, and is worth to be used in clinical practice.

Key words: Sepsis, White blood cell count, Platelet count, White blood cell-to-platelet ratio, Prognosis

CLC Number:

R631

CHEN Min, CHE Zaiqian, CHEN Ying, MA Li, ZHAO Bing, ZHOU Weijun, MAO Enqiang, CHEN Erzhen. Clinical study of leukocyte-to-platelet ratio in early evaluating prognosis of sepsis[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(03): 208-213.

Figures/Tables 5

References 31

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一般资料	存活组（n=126）	死亡组（n=24）	t或χ²	P
年龄（岁）	52.1±15.7	63.5±18.1	-3.161	0.685
男性	71（56.3）	10（41.7）	1.750	0.186
脓毒症休克	14（11.1）	16（66.7）	29.630	0.000
感染部位			3.684	0.298
肺	53（42.1）	10（41.7）
泌尿道	50（39.7）	9（37.5）
胆道	21（16.7）	3（12.5）
其他	2（1.6）	2（8.3）
基础疾病			1.779	0.619
无	26（20.6）	5（20.8）
糖尿病	44（34.9）	10（41.7）
高血压	14（11.1）	4（16.7）
高脂血症	42（33.3）	5（20.8）
收缩压（mmHg）	125.0±25.8	126.5±27.1	-0.240	0.911
舒张压（mmHg）	81.5±20.8	72.2±17.7	2.045	0.076
心率（次/min）	89.3±23.5	108.8±22.0	-3.768	0.601
氧合指数	372.5±180.9	115.8±48.7	21.276	0.000
血管活性药物	14（11.1）	16（66.7）	29.630	0.000
机械通气	32（25.4）	18（75.0）	22.321	0.000
血液净化	21（16.7）	10（41.7）	7.789	0.020
住院天数（d）	36.8±33.8	16.8±15.5	5.037	0.026

实验室检查	存活组（n=126）	死亡组（n=24）	t	P
WBC计数（×10⁹/L）	12.9±7.5	14.6±7.5	-0.946	0.382
PLT计数（×10⁹/L）	166.5±96.7	140.7±112.8	1.163	0.068
CRP（mg/L）	8.3±4.8	17.5±9.3	-3.915	0.207
PCT（mg/L）	6.4±2.2	25.7±9.1	-3.030	0.000
空腹血糖（mmol/L）	9.9±4.7	11.6±5.6	-1.495	0.148
尿素氮（mmol/L）	9.1±8.8	21.4±16.7	-5.310	0.000
肌酐（μmol/L）	121.4±81.1	205.6±141.0	-2.135	0.404
ALT（U/L）	60.6±37.4	71.0±39.9	-0.340	0.430
AST（U/L）	75.9±65.3	216.9±91.3	-2.270	0.000
APTT（s）	32.7±5.9	36.1±7.6	-2.159	0.211
PT（s）	14.1±2.4	15.5±4.3	-1.898	0.018
FDP（g/L）	21.7±4.9	38.9±8.4	-2.354	0.003
D-二聚体（mg/L）	7.1±6.1	13.7±4.2	-2.447	0.001
pro-BNP（mg/L）	2.0±0.6	11.1±1.4	-5.315	0.000
cTnI（μg/L）	1.1±0.3	2.1±1.1	-1.166	0.205
乳酸（mmol/L）	2.9±2.4	3.7±3.2	-0.516	0.223

项目	r	P
年龄	0.150	0.068
性别	0.108	0.188
收缩压	-0.078	0.341
舒张压	-0.046	0.574
心率	0.151	0.066
氧合指数	-0.146	0.157
CRP	0.220	0.007
PCT	0.457	0.000
空腹血糖	0.126	0.137
尿素氮	0.389	0.000
肌酐	0.188	0.021
ALT	0.020	0.806
AST	0.001	0.994
pro-BNP	0.370	0.000
cTnI	0.096	0.245
APTT	0.240	0.034
PT	0.213	0.061
FDP	0.243	0.032
D-二聚体	0.252	0.026
乳酸	0.105	0.611

相关因素	β	SE	Wald	OR	95%CI	P
WBC/PLT比值	0.413	0.200	4.253	1.511	1.021~2.236	0.039
尿素氮	0.024	0.012	3.909	1.024	1.000~1.048	0.048
SOFA评分	0.272	0.047	33.417	1.312	1.197~1.439	0.000