平均血小板体积与血小板计数比值对老年呼吸衰竭患者预后的评估价值

The value of the ratio of mean platelet volume to platelet count in evaluating the prognosis of elderly patients with respiratory failure

中文关键词: 老年  呼吸衰竭  平均血小板体积  血小板计数  28d死亡风险  预测价值

英文关键词: elderly  respiratory failure  mean platelet volume  platelet count  28-day mortality risk  predictive value

中文摘要:

      目的 探讨平均血小板体积与血小板计数比值(MPV/PLT)对老年呼吸衰竭患者预后的评估价值.方法 选取2022 年1 月—2022 年12 月上海市浦东新区浦南医院呼吸科和GICU住院的老年呼吸衰竭患者94 例,依据入组老年患者28d的存活情况分为生存组和死亡组,选取同期年龄和性别匹配的非呼吸衰竭40 例患者作为对照组.收集入组患者血小板计数(PLT)、平均血小板体积(MPV)、中性粒细胞比值(N)、血白细胞计数(WBC)、降钙素原(PCT)、血乳酸(Lac)、白介素-6(IL-6)、白介素-8(IL-8)等指标及急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分),计算MPV/PLT比值,比较生存组、死亡组、非呼吸衰竭组各指标间差异;采用受试者工作特征曲线(ROC)评估各项指标对老年呼吸衰竭患者28d的死亡风险的临床预测价值,采用多因素二元Logistic回归分析明确患者死亡的相关危险因素.结果 对照组的年龄、MPV、MPV/PLT低于生存组和死亡组,对照组的PLT高于死亡组,差异均有统计学意义(P＜0.05);死亡组PLT低于生存组,死亡组年龄、Lac、MPV、MPV/PLT、WBC、N、PCT、CRP、IL-6、IL-8、APACHEⅡ评分高于生存组,差异均有统计学意义(P＜0.05).MPV预测老年呼吸衰竭患者死亡风险的曲线下面积(AUC)为0.691,当最佳截断值为10.45时,敏感度为69.2%,特异度为69.7%.MPV/PLT预测患者死亡风险的曲线下面积(AUC)为 0.971,当最佳截断值为0.058 时,敏感度为84.6%,特异度为98.5%.APACHEⅡ评分预测患者死亡风险的AUC为0.998 当最佳截断值为16.5分时,敏感度为100%,特异度为93.9%.MPV、MPV/PLT、IL-8 和APACHEⅡ评分是老年呼吸衰竭患者28d死亡的独立危险因素(均P＜0.05).结论 MPV/PLT可作为简便而有效的指标来评估老年呼吸衰竭患者预后,在评估老年呼吸衰竭患者28d死亡风险具有良好的预测价值.

英文摘要:

      Objective To explore the value of the ratio of mean platelet volume to platelet count (MPV / PLT) in evalu? ating the prognosis of elderly patients with respiratory failure. Methods 94 elderly patients with respiratory failure admitted to Department of Respiratory and GICU of Punan Hospital, Pudong New District from January 2022 to December 2022 were se? lected. According to the 28 day survival status of the elderly patients, they were divided into survival group and death group. Additionally, 40 age—and gender?matched patients without respiratory failure were selected as the control group. The platelet count (PLT), mean platelet volume (MPV), neutrophil ratio (N), blood white blood cell count (WBC), procalcitonin (PCT), blood lactate (Lac), interleukin?6 (IL?6), interleukin?8?8 (IL?8) and Acute Physiological and Chronic Health Status II (APACHE II) score of the patients were collected, and the MPV / PLT ratio was calculated. The differences of above indexes were compared among the survival group, death group and control group. Receiver operating characteristic curve (ROC) was used to evaluate the clinical predictive value of each indicator for 28?day mortality risk in elderly patients with respiratory fail? ure. Multivariate binary logistic regression analysis was used to determine the risk factors of death. Results The age, MPV and MPV / PLT of the control group were lower than those of the survival and death groups, and the PLT of the control group was high?er than that of the death group, with statistical significances (P <0. 05). The PLT of the death group was lower than that of the survival group, while the age, Lac, MPV, MPV / PLT, WBC, N, PCT, CRP, IL?6, IL?8 and APACHE II scores of the death group were higher than those of the survival group, with statistical significances (P <0. 05). The area under the curve (AUC) of MPV for predicting the mortality risk in elderly patients with respiratory failure was 0. 691, with a sensitivity of 69. 2% and a spe? cificity of 69. 7% when the optimal cut?off value was 10. 45; AUC of MPV / PLT for predicting the mortality risk was 0. 971, with a sensitivity of 84. 6% and a specificity of 98. 5% when the optimal cut?off value was 0. 058; AUC of APACHE II score predic? ting the mortality risk was 0. 998, with a the sensitivity of 100% and a specificity of 93. 9% when the optimal cut?off value was16. 5. MPV, MPV / PLT, IL?8 and APACHE II scores were independent risk factors for 28?day death in elderly patients with respiratory failure (all P <0. 05). Conclusion MPV / PLT can be used as a simple and effective indicator to evaluate the progno? sis of elderly patients with respiratory failure, and has good predictive value in assessing the 28?day mortality risk of elderly pa? tients with respiratory failure.