The Value of NLR Combined SOFA in Assessing the Prognosis of Sepsis Patients

Abstract Background: In order to evaluate the risk factors and its assessment values in patients with sepsis, and to explore a method to improve the prognosis prediction efficiency of patients with sepsis.Methods: Patients with sepsis admitted to Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University from January 2020 to December 2020 were enrolled, and they were divided into survival group and death group according to the prognosis at 28 days. Demographic data of patients and laboratory values at admission were collected. In terms of the first time data within 24h of patients admitted to hospital, the sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were calculated, and compared the difference between the two groups, the logistic regression was used to analysis the risk factors for death within 28 days, as well as the calculated combined predictor of SOFA and neutrophil to lymphocyte ratio (NLR). Predicted values of various indicators for 28 days’ mortality in sepsis patients were analyzed by receiver operating characteristic (ROC) curve.Results: 302 patients in total were included in this study, including 238 patients in survival group and 64 patients in death group. The age (78.36±9.8 years old vs. 71.6±14.1 years old), procalcitonin (PCT) (1.00 ng/ml vs. 0.05 ng/ml), C-reactive protein (CRP) (93 mg/l vs 14 mg/l), lactic acid (Lac) (1.20 mmol/l vs. 2.20 mmol/l), NLR (11.7 vs. 6.20), SOFA score (8 vs. 4) and APACHE Ⅱ score(20.5 vs. 11.0) of death group were significantly higher than those of survival group (all P<0.001). Age (OR=1.046, 95%CI 1.020-1.074, P=0.001), PCT (OR=1.115, 95%CI 1.055-1.177, P<0.001), CRP (OR=1.016, 95%CI 1.011-1.021, P<0.001), Lac (OR=1.887, 95%CI 1.518-2.346, P<0.001), NLR (OR=1.038, 95%CI 1.016-1.060, P=0.001), APACHE Ⅱ score (OR=1.231, 95%CI 1.166-1.300, P<0.001), SOFA score (OR=1.499, 95%CI1.344-1.671, P<0.001), NLR combined SOFA (SOFA+NLR×0.085) (OR=1.492, 95%CI1.341-1.660, P<0.001) were risk factors of 28 days’ mortality in sepsis patients, and the area under the curve (AUC) of APACHE Ⅱ, NLR combined SOFA were 0.853 and 0.855, higher than Lac (0.767, P<0.05), CRP (0.746, P<0.05) and PCT (0.761, P<0.05), the AUC of APACHE Ⅱ was similar with NLR combine SOFA (P>0.05). The sensitivity and specificity of APACHE Ⅱ and NLR combined SOFA to predict the 28 days’ prognosis of sepsis patients were better than the other indicators. Conclusion: NLR combined SOFA was a risk factor for the death of sepsis patients, and its predictive efficacy was similar with that of APACHE Ⅱ score, which is superior to other predictive indexes.