Clinical significance of platelet-to-neutrophil ratio in patients with sepsis-induced coagulopathy

YU Yong-chun; ZHANG Yi-ming; He Long-ping; Peng En-lan; Deng Xing-ping; Song Jing-chun

doi:10.16048/j.issn.2095-5561.2024.02.01

Abstract：Objective To explore the clinical significance of the platelet-to-neutrophil ratio(PNR) in sepsis-induced coagulopathy (SIC). Methods A retrospective analysis was performed on 670 sepsis patients admitted to the Intensive Care Unit (ICU) of No. 908th Hospital of PLA from May 2018 to December 2022. The patients were divided into the sepsis group(n=405) and the SIC group (n=265) based on whether they had septic coagulation disease. Routine blood,biochemical,and coagulation function indicators within 2 hours of admission were collected.The Random Forest algorithm was used for risk factor analysis,the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of variables,and the Kaplan-Meier method was used to plot survival curves. Results White blood cell count,platelet count,PNR,hemoglobin,albumin,and fibrinogen levels of the SIC group were lower than those of the sepsis group,and the differences were statistically significant(P＜0.05). Alanine aminotransferase,aspartate aminotransferase,total bilirubin,blood creatinine,C-reactive protein,lactic acid,thrombomodulin,thrombin-antithrombin complex,tissue plasminogen activator-inhibitor complex,fibrin degradation products,D-dimer,acute physiology and chronic health evaluation Ⅱ score,ICU mortality rate of the SIC group were higher than those of the sepsis group,and prothrombin time,activated partial thromboplastin time,thrombin time of the SIC group were longer than those of the sepsis group,and the differences were statistically significant(P＜0.05). The Random Forest algorithm results showed that PNR was an independent risk factor for the occurrence of SIC (P＜0.05). The area under the ROC curve for PNR diagnosis of septic coagulation disease was 0.76(95％ credibility interval 0.68-0.88,P＜0.01),and when the PNR was set at the optimum cutoff value 13.1,the sensitivity and specificity of PNR for diagnosing SIC were 79.8％ and 63.8％,respectively.The Kaplan-Meier analysis results show that the 28-day survival rate of septic patients with PNR≥13.1 was 1.46 times that of the PNR＜13.1 group(95％ credibility interval 1.04-2.04),with a statistically significant difference(P＜0.05). Conclusion PNR can be used as a biomarker for predicting sepsis-induced coagulopathy. When PNR ratio is less than 13.1,the 28-day mortality of sepsis patients increases significantly.