血培养阳性报警时间联合降钙素原、中性粒细胞/淋巴细胞比值对大肠埃希菌血流感染患者死亡风险的预测价值

摘要 目的：探讨血培养阳性报警时间（TTP）联合降钙素原（PCT）、中性粒细胞/淋巴细胞比值（NLR）对大肠埃希菌血流感染（BSI）患者死亡风险的预测价值。方法：选取2020年1月～2022年6月我院收治的223例大肠埃希菌BSI患者，根据入院后28 d内是否死亡分为死亡组和存活组。收集患者临床资料和血培养TTP，检测PCT、NLR。采用多因素Logistic回归分析大肠埃希菌BSI患者死亡的影响因素。采用受试者工作特征（ROC）曲线分析TTP、PCT、NLR对大肠埃希菌BSI患者死亡风险的预测价值。结果：223例大肠埃希菌BSI患者入院后28 d内死亡率为30.04％（67/223）。死亡组TTP短于存活组，PCT、NLR高于存活组（P均＜0.001）。多因素Logistic回归分析显示，年龄增加、入住重症监护病房（ICU）、气管插管/切开、PCT升高、NLR升高为大肠埃希菌BSI患者死亡的独立危险因素，TTP延长为独立保护因素（P＜0.05）。ROC曲线分析显示，TTP、PCT、NLR联合预测大肠埃希菌BSI患者死亡的曲线下面积大于各指标单独预测。结论：TTP缩短和PCT、NLR升高与大肠埃希菌BSI患者死亡风险增加相关，TTP、PCT、NLR联合预测大肠埃希菌BSI患者死亡风险的价值较高。

Predictive Value of Blood Culture Time to Positivity Combined with Procalcitonin and Neutrophil/Lymphocyte Ratio on the Risk of Death in Patients with Escherichia Coli Bloodstream Infection

ABSTRACT Objective: To investigate the predictive value of blood culture time to positivity (TTP) combined with procalcitonin (PCT) and neutrophil/lymphocyte ratio (NLR) on the risk of death in patients with Escherichia coli bloodstream infection (BSI). Methods: 223 cases of patients with Escherichia coli BSI who were admitted to our hospital from January 2020 to June 2022 were selected, and they were divided into death group and survival group according to whether they died within 28 d of admission. Clinical data and blood culture TTP of patients were collected, and the PCT and NLR were detected. Multivariate Logistic regression was used to analyze the influencing factors of death in patients with Escherichia coli BSI. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of TTP, PCT and NLR on the risk of death in patients with Escherichia coli BSI. Results: The mortality rate of 223 patients with Escherichia coli BSI within 28 d after admission was 30.04% (67/223). The TTP of the death group was shorter than that of the survival group, and the PCT and NLR were higher than those of the survival group (all P<0.001). Multivariate Logistic regression analysis showed that increased age, admission to intensive care unit (ICU), tracheal intubation/incision, increased PCT and increased NLR were independent risk factors for death in patients with Escherichia coli BSI, and prolonged TTP was an independent protective factor (P<0.05). ROC curve analysis showed that the area under curve of TTP, PCT and NLR combined to predict the death of patients with Escherichia coli BSI was greater than that of each index alone. Conclusion: Shortened TTP and increased PCT and NLR are associated with increased risk of death in patients with Escherichia coli BSI. The combination of TTP, PCT and NLR has a high value in predicting the risk of death in patients with Escherichia coli BSI.