Abstract：Objective To analyze the diagnostic effectiveness of hematological indicators such as CRP, PCT, PLR and PDW on infectious mononucleosis (IM) co-infection with bacterial infection, and to establish a more optimal multifactorial diagnostic model based on this, in order to quickly and timely determine whether IM patients are combined with bacterial infection, to guide the rational use of antibiotics and avoid early antibiotic abuse. Methods From October 2019 to January 2023, the clinical data of IM patients admitted to the Department of Otolaryngology, Hunan Provincial People's Hospital were included, and patients were divided into infected and non-infected groups according to whether they were co-infected with bacterial infections. The difference factors between groups were analyzed by statistical analysis with multi-factor logistic regression, and independent predictors were screened and combined with the above factors to establish a PRML diagnostic model. Afterwards, the area under ROC curve, sensitivity and specificity were used to compare the diagnostic effectiveness of the model and the independent factors on the IM co-infection with bacterial infection. Results Four independent predictors, PCT, CRP, PLR, and PDW, were screened by logistic regression analysis, and their OR were 1.038, 1.045, 0.923, and 1.060, respectively. The area under ROC curve showed that the diagnostic effectiveness of the PRML diagnostic model (AUC=0.928) developed by combining the above independent predictors was significantly higher than that of PCT (AUC=0.770), CRP (AUC=0.720), PLR (AUC=0.667), and PDW (AUC=0.687). Conclusion The PRML model developed by combining PCT, CRP, PLR, and PDW is helpful for clinical diagnosis of IM co-infection with bacterial infection, and its diagnostic effectiveness is superior to each independent predictor alone.
[1] 袁胜男, 赵俊暕, 韩晓燕, 等. 细菌与真菌感染对血小板的影响研究[J]. 中华医院感染学杂志, 2016, 26(22): 5083-5086. [2] Fogagnolo A, Campo GC, Mari M, et al.The Underestimated Role of Platelets in Severe Infection a Narrative Review[J]. Cells, 2022, 11(3): 424. [3] 中华医学会儿科学分会感染学组. 儿童EB病毒感染相关疾病的诊断和治疗原则专家共识[J]. 中华儿科杂志, 2021, 59(11): 905-911. [4] Horan TC, Andrus M, Dudeck MA.CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting[J]. Am J Infect Control, 2008, 36(5): 309-332. [5] Lennon P, Crotty M, Fenton JE.Infectious mononucleosis[J]. BMJ, 2015, 350: h1825. [6] Houen G, Trier NH.Epstein-Barr Virus and Systemic Autoimmune Diseases[J]. Front Immunol, 2020, 11: 587380. [7] Cohen JI, Dropulic L, Hsu A P, et al.Association of GATA2 Deficiency With Severe Primary Epstein-Barr Virus (EBV) Infection and EBV-associated Cancers[J]. Clin Infect Dis, 2016, 63(1): 1-7. [8] 王涛, 华益民, 周开宇, 等. 传染性单核细胞增多症继发医院细菌感染患儿的临床特点及病原学分析[J]. 中华实用儿科临床杂志, 2017, 32(22): 1717-1720. [9] Kamat IS, Ramachandran V, Eswaran H, et al.Procalcitonin to Distinguish Viral From Bacterial Pneumonia: A Systematic Review and Meta-analysis[J]. Clin Infect Dis, 2020, 70(3): 538-542. [10] Povsic M K, Beovic B, Ihan A.Perioperative Increase in Neutrophil CD64 Expression is an Indicator for Intra-abdominal Infection after Colorectal Cancer Surgery[J]. Radiol Oncol, 2017, 51(2): 211-220. [11] Del Giudice M, Gangestad SW.Rethinking IL-6 and CRP: Why they are more than inflammatory biomarkers, and why it matters[J]. Brain Behav Immun, 2018, 70: 61-75. [12] Sproston NR, Ashworth JJ.Role of C-Reactive Protein at Sites of Inflammation and Infection[J]. Front Immunol, 2018, 9: 754. [13] De Jager CPC, van Wijk PTL, Mathoera RB, et al. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit[J]. Critical Care, 2010, 14(5): R192. [14] 陈约慧, 应芙蓉, 詹玲玲, 等. 系统性炎症指标及痰液细菌培养在慢性阻塞性肺疾病患者中的临床价值[J]. 中国卫生检验杂志, 2018, 28(24): 2956-2959. [15] 李妍, 国虹, 孙成栋. 白血病感染患者hs-CRP、PCT水平与血小板参数的变化及其相关性研究[J]. 临床和实验医学杂志, 2020, 19(8): 882-885. [16] 韩静, 刘晓宇, 翁军, 等. PDW、BNP 及 LDH 在 COPD 合并 PH 患者中的变化及其临床意义[J]. 分子诊断与治疗杂志, 2021, 13(8): 1268-1271. [17] 刘乔乔, 许能銮, 陈海燕, 等. 血小板参数、PDW_PLT和MPV_PLT变化对社区获得性肺炎患者预后评估价值[J]. 福建医科大学学报, 2020, 54(3): 156-160.
2023, Vol. 20 
