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응급실로 내원한 급성 신우신염 여성 환자의 중증도 예측을 위한 호중구와 림프구의 수치비의 역할

The role of the neutrophil-to-lymphocyte ratio for the prediction severity in women with acute pyelonephritis in the emergency department

대한응급의학회지 2020년 31권 6호 p.562 ~ 569
송백호, 박상현, 소병학, 김수현, 주종호, 최승필, 오재훈,
소속 상세정보
송백호 ( Song Back-Ho ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine
박상현 ( Park Sang-Hyun ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Emergency Medicine
소병학 ( So Byung-Hak ) - Catholic University College of Medicine St. Vincent’s Hospital Department of Emergency Medicine
김수현 ( Kim Soo-Hyun ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Emergency Medicine
주종호 ( Zhu Jong-Ho ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Emergency Medicine
최승필 ( Choi Seung-Pill ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Emergency Medicine
오재훈 ( Oh Jae-Hun ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Emergency Medicine

Abstract


Objective: It is difficult to predict medical outcomes for acute pyelonephritis (APN) in women. A delay in diagnosis and treatment results in rapid progression to circulatory collapse, multiple organ failure, and death. We investigated the value of procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) in APN patients hospitalized through the emergency room.

Method: We retrospectively evaluated women with APN presenting in the emergency room from January 2014 to May 2018. Inflammatory biomarkers, including PCT and NLR, were measured, and the severity of pyelonephritis was assessed using the Surviving Sepsis Campaign definitions (Sepsis-3). Multivariable logistic regression analysis was used to evaluate the risk factors associated with septic shock and the prediction for septic shock was compared using a receiver operating characteristic (ROC) curve.

Results: A total of 357 female patients with APN were included. The median level of PCT and NLR was higher in the septic shock group compared with other groups. Multivariate logistic regression analysis showed that age and PCT were risk factors for septic shock. When the ROC curve of septic shock was compared, PCT showed a higher area under the curve than NLR (NLR 0.65 vs. PCT 0.80).

Conclusion: The initial NLR in the emergency room showed significant differences depending on the severity as classified by Sepsis-3 definitions. However, NLR was not found to be associated with septic shock in female patients with APN.

키워드

Neutrophil count; Lymphocyte count; Acute pyelonephritis; Neutrophil to lymphocyte ratio

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