摘要
目的探讨血细胞计数及相关参数是否可以预测流感合并下呼吸道感染患者的预后。方法回顾性研究2013年至2023年首都医科大学附属北京朝阳医院经急诊医学科、发热门诊或呼吸科收治入院或留观的流感合并下呼吸道感染患者,以28天死亡为研究终点,分为生存组和死亡组,比较分析两组间血细胞计数及相关参数的差异,回归分析死亡的独立预测因素,建模并对模型进行评价。结果此项研究最终纳入417例患者,28天生存组361例(86.6%),死亡组56例(13.4%)。死亡组淋巴细胞计数和血小板计数显著低于生存组,红细胞分布宽度、血小板分布宽度、血小板平均体积及大血小板比率显著高于生存组(P<0.05)。多变量Logistic回归分析筛选独立相关变量,当淋巴细胞计数≤0.68×10^(9)/L,或血小板计数≤147×10^(9)/L,或红细胞分布宽度>12.7%,或血小板分布宽度>13.9 fL时,患者28天死亡风险增加,四个指标建立预测模型的AUC为0.734(95%CI 0.664~0.804),敏感度58.9%,特异度80.4%,阳性预测值32.0%,阴性预测值92.7%,阳性似然比3.01,阴性似然比0.51。模型的一致性指数为0.735,拟合优度Hosmer-Lemeshow检验显示拟合效果较好(P=0.406)。结论淋巴细胞计数、血小板计数、红细胞分布宽度、血小板分布宽度可作为早期预测流感合并下呼吸道感染患者28天死亡风险的指标,以这些指标构建的列线图模型可计算临床实测值所对应的死亡风险概率。
Objective To investigate whether blood cell counts and related parameters can predict the prognosis of influenza patients with lower respiratory tract infection.Methods A retrospective study was conducted on the patients of influenza combined with lower respiratory tract infection admitted to or kept in the Emergency Medicine Department,Fever Clinic or Respiratory Department of Beijing Chaoyang Hospital,Capital Medical University from 2013 to 2023.The patients were divided into survival group and death group based on 28-day death as the study endpoint,and the differences of blood cell counts and related parameters between the two groups were compared and analyzed.Independent predictors of death were also screened by Logistic regression,and the prediction model was constructed and evaluated.Results A total of 417 patients were enrolled in the study,including 361 patients(86.6%)in the 28-day survival group and 56 patients(13.4%)in the 28-day death group.The lymphocyte count and platelet count in the death group were significantly lower than those in the survival group.The red blood cell distribution width,the platelet distribution width,the mean platelet volume and the large platelet ratio in the death group were higher than those in the survival group(P<0.05).Multivariate Logistic regression analysis screened independent correlated variables,and found when lymphocyte count≤0.68×10^(9)/L,or platelet count≤147×10^(9)/L,or red blood cell distribution width>12.7%,or platelet distribution width>13.9 fL,the patients had an increased risk of 28-day mortality.The AUC of the predictive model established by the four indicators was 0.734(95%CI 0.664-0.804),sensitivity was 58.9%,specificity was 80.4%,positive predictive value was 32.0%,negative predictive value was 92.7%,positive likelihood ratio was 3.01,and negative likelihood ratio was 0.51.The concordance index of the model was 0.735,and Hosmer-Lemeshow goodness of fit test showed a good effect(P=0.406).Conclusions Lymphocyte count,platelet count,red blood cell distribution width and platelet distribution width can be used as early indicators to predict the 28-day mortality risk in the patients with influenza-associated lower respiratory tract infection.The mortality risk probability corresponding to clinical measurements can be calculated according to the nomogram.
作者
腾飞
郭睿文
梁梦琳
梅雪
Teng Fei;Guo Ruiwen;Liang Menglin;Mei Xue(Emergency Medicine Center,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中国急救医学》
CAS
CSCD
2024年第4期287-291,共5页
Chinese Journal of Critical Care Medicine
基金
北京市医院管理中心临床医学发展专项“扬帆”计划(ZYLX202132)
北京市医院管理中心“培育”计划(PX2023012)。
关键词
流感
下呼吸道感染
红细胞分布宽度
血小板分布宽度
淋巴细胞计数
血小板计数
Influenza
Lower respiratory tract infection
Red blood cell distribution width
Platelet distribution width
Lymphocyte count
Platelet count
作者简介
腾飞(1983-)男,博士,副主任医师,E-mail:tengfei.vip@139.com;通信作者:梅雪(1971-),男,博士,主任医师,E-mail:meixue91@yeah.net。
