The value of neutrophil-to-lymphocyte ratio combined with mean platelet volume-to-platelet count ratio in predicting the prognosis of patients with septic shock

Objective To investigate the value of early peripheral blood neutrophil-to-lymphocyte Ratio (NLR) combined with mean platelet volume-to-platelet count ratio (MPV/PLT) in evaluating the prognosis in patients with septic shock.

Methods A total of 112 patients with infectious stroke who were hospitalized were retrospectively selected. According to the prognosis of the patients within 28 days, they were divided into survival group(n=69) and death group (n=43). Age, gender, shock index, oxygenation index, C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC), lactic acid (Lac), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, D-dimer, NLR and MPV/PLT within 24 hours after admission were recorded. The receiver operating characteristic curve (ROC) was used to evaluate the clinical predictive value of various indicators for the 28-day mortality risk of patients with septic shock. Multivariate Logistic regression was used to analyze the risk factors for the prognosis of patients with septic shock. Kaplan-Meier survival curve was used to analyze the correlations of different NLR-MPV/PLT scores with overall survival.

Results There were no significant differences in age, gender, shock index, oxygenation index, and CRP between the two groups (P>0.05). Compared with the survival group, NLR, MPV/PLT, WBC, PCT, Lac, D-dimer, APACHEⅡ score and SOFA score in the death group were higher than those in the control group(P < 0.05). The area under the curve (AUC) of NLR in predicting death risk was 0.724, when the optimal cut-off value was 12.49, the sensitivity was 74.4% and the specificity was 68.1%. The AUC for MPV/PLT in predicting death risk was 0.731, with a sensitivity of 74.4% and specificity of 69.6% when the optimal cut-off value was 0.10. NLR, MPV/PLT, WBC, PCT, Lac and D-dimer were independent influencing factors of death in septic shock patients at 28 d (P < 0.05). Patients with septic shock were divided into 0 score group, one score group, two scores group according to NLR-MPV/PLT score, the 28-day cumulative survival rates were 88.2%, 70.2% and 19.4%, respectively(P < 0.05).

Conclusion Early NLR and MPV/PLT have high predictive value for the prognosis of septic shock patients, which can be used as effective and simple evaluation index for early diagnosis of emergency patients and clinical guidance for follow-up treatment.