摘要
目的探讨先天性心脏病(CHD)患儿手术前中性粒细胞淋巴细胞比值(NLR)及其他因素与术后医院感染的关系。方法收集2006至2017年行心脏手术患儿11937例,根据NLR随年龄增长分布的变化拐点及发生医院感染与否将患儿分为<224天感染组和未感染组及≥224天感染组和未感染组,分析其术后医院感染的风险因素。结果11937例患儿中男6746例、女5191例,中位年龄316.0(175.0~838.0)d。发生医院感染1325例(占11.1%),其中<224天830例(19.15%)、≥224天495例(6.51%)。<224天患儿的医院感染率高于≥224天患儿,差异有统计学意义(P<0.001)。二分类logistic回归分析发现,NLR高、体外循环持续时间长、术前有感染、STS风险评级≥3是<224天患儿术后发生医院感染的独立风险因素(P<0.05);而年龄大、淋巴细胞白细胞比值(LWR)异常是<224天患儿术后发生医院感染的独立保护因素(P<0.05)。心脏手术史、术前有感染、STS风险评级≥3、ALT异常、AST异常是≥224天患儿术后发生医院感染的独立风险因素(P<0.05);而年龄大、BMI-Z评分高以及LWR异常是≥224天患儿术后发生医院感染的独立保护因素(P<0.05)。NLR预测<224天患儿术后发生医院感染的曲线下面积(AUC)为0.594(95%CI:0.572~0.617);当NLR>0.542时,其诊断医院感染的灵敏度为41.8%、特异度为73.6%。结论近年CHD患儿术后感染率有所降低。年龄小、BMI-Z评分低、术前感染、手术复杂、手术时间长和NLR升高是CHD患儿术后感染的风险因素。
Objective To investigate the relationship between preoperative neutrophil lymphocyte ratio(NLR)and other factors and postoperative nosocomial infection in children with congenital heart disease(CHD).Methods A total of 11937 children who underwent cardiac surgery from 2006 to 2017 were collected.According to the inflection point of NLR distribution with age and whether nosocomial infection occurred,the children with the age of<224 days and≥224 days were divided into infected group and non-infected group,respectively.The risk factors of postoperative nosocomial infection were analyzed.Results Among 11937 patients,there were 6746 boys and 5191 girls,with a median age of 316.0(175.0-838.0)days.Nosocomial infection occurred in 1325 children(11.1%).There were 830(19.15%)children with the age of<224 days and 495(6.51%)children≥224 days.The nosocomial infection rate of children<224 days was higher than that of children≥224 days,and the difference was statistically significant(P<0.001).Binary logistic regression analysis showed that higher NLR level,longer cardiopulmonary bypass duration,preoperative infection,and STS risk rating≥3 were independent risk factors for postoperative nosocomial infection in children<224 days(P<0.05).However,older age,abnormal lmphocyte white blood cell ratio(LWR)were independent protective factors for postoperative nosocomial infection in children<224 days(P<0.05).The history of cardiac surgery,preoperative infection,STS risk rating≥3,abnormal ALT and AST were independent risk factors for postoperative nosocomial infection(P<0.05),While older age,higher BMI-Z score and abnormal LWR were independent protective factors for postoperative nosocomial infection in children≥224 days(P<0.05).The area under the curve(AUC)of NLR for predicting nosocomial infection in children<224 days was 0.594(95%CI:0.572~0.617).When NLR>0.542,its sensitivity and specificity for diagnosing nosocomial infection were 41.8%and 73.6%.Conclusion The postoperative infection rate of CHD children has decreased in recent years.Younger age,low BMI-Z score,preoperative infection,complex surgery,long operation time and increased NLR are the risk factors for postoperative infection in CHD children.
作者
罗润娇
杜欣为
龚霄雷
陈一玮
郝泽东
王伟
LUO Runjiao;DU Xinwei;GONG Xiaolei;CHEN Yiwei;HAO Zedong;WANG Wei(Department of Thoracic and Cardiovascular Surgery,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2022年第1期51-57,共7页
Journal of Clinical Pediatrics
基金
国家自然科学基金资助项目(No.82070430)。
