The correlation between inflammatory indicators related to blood routine and bloodstream infections in blood disease patients with neutropenia
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摘要: 目的 评估血常规相关炎性指标用于筛查中性粒细胞减少(chemotherapy-induced neutropenia，CIN)的血液病患者发生血流感染(bloodstream infection，BSI)的价值。方法 回顾性分析2021年8月1日—2024年7月31日就诊于医院血液内科，出现化疗导致CIN的205例血液病患者的临床资料。收集患者疑诊BSI进行血培养及鉴定，收集同时间段血常规参数(白细胞、中性粒细胞、淋巴细胞、单核细胞、血小板)的检测结果，并计算相关炎性指标：中性粒细胞计数与淋巴细胞计数比值(NLR)、单核细胞计数与淋巴细胞计数比值(MLR)、血小板计数与淋巴细胞计数比值(PLR)、全身炎症反应指数(SIRI)、全身免疫炎症指数(SII)。根据是否发生BSI分为BSI组(55例)和非BSI组(150例)，比较两组血常规参数以及各炎性指标的水平。受试者工作特征(ROC)曲线分析各炎性指标筛查CIN血液病患者发生BSI的诊断价值。结果 BSI组血常规各参数、各炎性指标水平除PLR外均明显低于非BSI组，差异有统计学意义(P＜0.05)。ROC分析显示NLR、MLR、SIRI、SII均可有效筛查BSI，曲线下面积(AUC)范围0.678~0.816，其中单项指标SII的AUC最高(0.816)，当SII＜8.089时灵敏度、阴性预测值最高；SIRI＜0.008时其特异度、阳性预测值最高。结论 CIN血液病患者发生BSI时炎性指标NLR、MLR、SIRI、SII水平明显下降，各项炎性指标中SII是最合适用于筛查BSI的炎性指标，当SII＜8.089时可基本排除BSI的发生。Abstract: Objective To evaluate the value of inflammatory indicators related to routine blood tests in screening for bloodstream infections(BSI) among blood disease patients with neutropenia.Methods A retrospective analysis was conducted on the clinical data of 205 patients with hematological diseases who experienced chemotherapy-induced neutropenia(CIN) at our hospital, spanning from August 1, 2021, to July 31, 2024. Concurrently, the results of blood routine parameters(including white blood cell, neutrophils, lymphocyte, monocyte and platelet) were collected from patients suspected of having bloodstream infection(BSI), and relevant inflammatory indicators were calculated: neutrophils-to-lymphocyte ratio(NLR), monocyte-to-lymphocyte ratio(MLR), platelet-to-lymphocyte ratio(PLR), systemic inflammatory response index(SIRI) and systemic immune inflammatory index(SII). Subsequently, the patients were categorized into two groups: BSI group(55 cases) and non-BSI(NBSI) group(150 cases), based on the occurrence of BSI. A comparative analysis was performed to evaluate the differences in levels of blood routine parameters and various inflammatory indicators between these two groups. Additionally, a receiver operating characteristic curve(ROC) analysis was conducted to assess the diagnostic value of various inflammatory indicators in screening for BSI among CIN hematological disease patients.Results The blood routine parameters and inflammatory index levels in the BSI group were significantly lower than those in the non-BSI group, with the exception of PLR, and these differences were statistically significant. ROC analysis demonstrated that NLR, MLR, SIRI, and SII can all serve as effective screening tools for BSI, exhibiting an area under the curve(AUC) ranging from 0.678 to 0.816. Notably, the AUC for the single indicator SII was the highest(0.816), achieving the greatest sensitivity and negative predictive value(NPV) when SII was less than 8.089. Conversely, when SIRI was less than 0.008, it displayed the highest specificity and positive predictive value(PPV).Conclusion When patients with CIN blood disease develop BSI, the levels of inflammatory markers such as NLR, MLR, SIRI and SII significantly decrease. Among these various inflammatory markers, SII is the most suitable for screening for BSI. Specifically, when SII is less than 8.089, the occurrence of BSI can be essentially ruled out.
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Key words:
- inflammatory indicators /
- blood disease /
- neutropenia /
- bloodstream infections
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表 1 BSI患者病原菌分布
病原菌 例数 构成比/% G- 大肠埃希菌 17 27.87 铜绿假单胞菌 14 22.95 肺炎克雷伯菌肺炎亚种 11 18.03 产气克雷伯菌 2 3.28 阴沟肠杆菌 1 1.64 嗜水气单胞菌 1 1.64 嗜麦芽寡养单胞菌 1 1.64 皮氏罗尔斯通氏菌 1 1.64 合计 48 78.69 G+ 金黄色葡萄球菌 4 6.56 缓症链球菌 2 3.28 肺炎链球菌 1 1.64 孔科氏葡萄球菌 1 1.64 蜡样芽孢杆菌 1 1.64 口腔链球菌 1 1.64 牛链球菌Ⅱ型 1 1.64 少酸链球菌 1 1.64 屎肠球菌 1 1.64 合计 13 21.31 总计 61 100.00 
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表 2 两组血常规参数及炎性指标的比较
M(P25，P75) 类型 BSI组(n=55) NBSI组(n=150) 统计值 P 年龄/岁 48(35，60) 55(44，65) -1.840 0.066 男性占比/% 45.45 58.67 2.840 0.092 血常规参数 WBC/(×109/L) 0.24(0.14，0.37) 1.13(0.56，2.25) -8.096 ＜0.001 中性粒细胞/(×109/L) 0.01(0.01, 0.04) 0.33(0.07, 0.74) -7.344 ＜0.001 淋巴细胞/(×109/L) 0.17(0.10, 0.25) 0.47(0.27, 0.83) -6.881 ＜0.001 单核细胞/(×109/L) 0.01(0.01, 0.04) 0.10(0.03, 0.34) -6.209 ＜0.001 PLT/(×109/L) 10(3, 25) 32(15, 88) -5.892 ＜0.001 炎性指标 NLR 0.118(0.048, 0.286) 0.605(0.208, 1.474) -5.432 ＜0.001 MLR 0.100(0.022, 0.184) 0.237(0.092, 0.593) -3.900 ＜0.001 PLR 75.000(16.667, 114.286) 71.429(32.500, 192.593) -1.327 0.184 SIRI 0.001(0, 0.009) 0.072(0.010, 0.381) -6.352 ＜0.001 SII 1.000(0.160, 3.391) 20.170(3.576, 68.406) -6.921 ＜0.001
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表 3 NLR、MLR、SIRI、SII筛查CIN血液病发生BSI的性能评价
炎性指标 截断值 Youden
指数AUC(95%CI) 灵敏度
/%特异度
/%阳性
预测值/%阴性
预测值/%NLR 0.366 0.498 0.744(0.667~0.820) 81.82 68.00 48.39 91.07 MLR 0.192 0.310 0.678(0.595~0.761) 76.36 54.67 38.18 86.32 SIRI 0.008 0.501 0.797(0.731~0.752) 72.73 77.33 54.05 88.55 SII 8.089 0.558 0.816(0.752~0.879) 89.09 66.67 49.49 94.34
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