ABSTRACT
Objective:
To determine the
ability of the ratio of
platelet to
lymphocyte (PLR) for predicting extubation failure in septic
patients receiving invasive
mechanical ventilation (IMV).
Methods:
The retrospective
cohort study was conducted in ICU at
Beijing Chao-Yang
Hospital Shijingshan District,
Capital Medical
University in
China from January, 2010 to December, 2019, including
patients with
sepsis who received IMV. 180
patients were enrolled in the study, including 111
male and 69
female, with the age range of 23-93 years and the median age of 76 years, and with an average age of 71.22 years. The
medical records were reviewed, such as age,
sex,
acute physiology and chronic health evaluation II (APACHEII), sequential organ failure assessment (SOFA), spontaneous
breathing trial (SBT) outcome,
weaning outcome,
complete blood count before SBT. According to
weaning outcome,
patients were divided into
weaning failure and
weaning success group. The difference of PLR,
white blood cell(WBC), C-reaction
protein (CRP) and
procalcitonin (PCT) were compared between
weaning failure and success group. Receiver-operating characteristics (ROC) curves and multivariate logistical
regression analysis were employed to analyze the performance of these inflammatory markers for predicting
weaning failure in
patients with
sepsis.
Results:
180
patients with
sepsis were included in the study and 37
patients (20.5%) experienced
weaning failure (31 SBT failure and 6 extubation failure after successful SBT). PLR was higher in
weaning failure group than that in
weaning success group (Z=-5.793,P<0.001). Other
inflammation biomarkers such as WBC, CRP and PCT were also higher in
weaning failure group than that in
weaning success group(Z=-4.356, -3.118 and -2.743, P<0.001, 0.002 and 0.006, respectively). According to
ROC curves, PLR has a better predictive
ability for
weaning failure (
AUC=0.809,95%CI 0.733-0.885) when compared to WBC (
AUC=0.773,95%CI 0.648-0.817), CRP (
AUC=0.666,95%CI 0.577-0.755) and PCT (
AUC=0.603,95%CI 0.508-0.698). The cutoff value of PLR for predicting
weaning failure was 257.69 with
sensitivity 78.38%,
specificity 76.22%, and diagnostic accuracy 71.66%. According to multivariate
logistic regression analyses, PLR>257.69 was an independent
risk factor for predicting
weaning failure in
patients with
sepsis.
Conclusions:
PLR may be a valuable
biomarker for predicting
weaning failure in septic
patients receiving IMV, and the
patients with higher PLR should be handled with caution since they are at higher
risk of
weaning failure, and some more effective
treatment should be in consideration after extubation.