高敏C反应蛋白与血清白蛋白比值对院内心脏骤停患者预后的预测价值  

The value of hs-CRP and albumin ratio in predicting the prognosis of patients with in-hospital cardiac arrest

作　　者：刘畅 王金龙 仲轶 刘蓓 王吉慧 苏成磊 陈可 赵宁军 翟丽梅 彭易根 花嵘 燕宪亮 许铁 Liu Chang;Wang Jinlong;Zhong Yi;Liu Bei;Wang Jihui;Su Chenglei;Chen Ke;Zhao Ningjun;Zhai Limei;Peng Yigen;Hua Rong;Yan Xianliang;Xu Tie(Emergency Medicine Department,the Affi liated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Graduate School of Xuzhou Medical University/Department of Emergency and Rescue Medicine,Xuzhou Medical University,Xuzhou 220002,China;Jiangsu Provincail Institute of Health Emergency/Xuzhou Key Laboratory of Emergency Medicine,Xuzhou 220002,China;Emergency Medicine Department,the Affi liated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]徐州医科大学附属医院急诊医学科,221002 [2]徐州医科大学研究生院&急救与救援医学系,221002 [3]江苏省卫生应急研究所&徐州市急诊医学重点实验室,徐州221002 [4]南京医科大学附属江宁医院急诊科,211100

出　　处：《中华急诊医学杂志》2021年第8期1002-1006,共5页Chinese Journal of Emergency Medicine

基　　金：国家科技基础资源调查(2018FY100601)。

摘　　要：目的探讨高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)与血清白蛋白(Albumin,Alb)比值对院内心脏骤停(in-hospital cardiac arrest,IHCA)患者预后的判断价值。方法连续入选2017年1月1日至2020年09月30日期间在徐州医科大学附属医院收治的IHCA后经心肺复苏(cardiopulmonary resuscitation,CPR)自主循环恢复(restoration of spontaneous circulation,ROSC)的患者为研究对象,按照IHCA后14 d是否存活分为存活组和死亡组,分析IHCA患者高敏C反应蛋白与血清白蛋白比值(hs-CRP/Alb)与预后的相关性。结果存活组和死亡组的性别、年龄、既往病史、使用心电监护、复苏时通气方式、首次监测心率人数所占比例、复苏前Alb等指标的差异无统计学意义(P>0.05);非心源性CA、使用肾上腺素剂量>5 mg占比,CPR持续时间,血乳酸、Alb和hs-CRP浓度,以及hs-CRP/Alb比值等指标的差异有统计学意义(P<0.05)。Logistic回归分析显示肾上腺素剂量>5 mg占比,血乳酸浓度、心肺复苏持续时间、hs-CRP/Alb比值是预测死亡的独立危险因素。ROC曲线分析显示hs-CRP/Alb比值、血hs-CRP和Alb浓度对患者死亡均有一定预测价值;曲线下面积分别为0.876、0.864、0.745,hs-CRP/Alb比值的预测效能优于hs-CRP浓度或Alb浓度。结论hs-CRP/Alb比值对IHCA患者的预后有一定预测价值,且预测效能优于单用血hs-CRP浓度或Alb浓度。Objective To investigate the predicting value of high sensitivity C-reactive protein(hs-CRP)and albumin(Alb)ratio on prognosis of patients with in-hospital cardiac arrest(IHCA).Methods A total of 107 patients with IHCA and spontaneous circulation recovery(ROSC)after cardiopulmonary resuscitation(CPR)in the Affiliated Hospital of Xuzhou Medical University during January 1,2017 and September 30,2020 were selected as the subjects and divided into the survival group and death group according to the survival condition on day 14 after IHCA.The correlation between ratio of high sensitivity C-reactive protein/albumin(hs-CRP/Alb)and the prognosis of patients was analyzed.Results No statistical significant differences were found between the survival and death groups in sex,age,medical history,ECG monitoring,recovery ventilation mode,percentage of first monitoring of heart rate and pre-resuscitation Alb(all P>0.05).However,there were signifi cant differences in the percentage of non-cardiogenic CA and adrenaline dose>5 mg,time of CPR,concentrations of blood lactic acid,Alb,hs-CRP,and ratio of hs-CRP/Alb(all P<0.05).Logistic regression analysis showed that percentage of adrenaline dose>5 mg,concentration of blood lactic acid,time of CPR,and ratio of hs-CRP/Alb were independent risk factors for predicting death.ROC curve analysis showed that hs-CRP/Alb ratio,and concentration of hs-CRP and Alb had predictive value on the death of patients with IHCA;the areas under the curves of hs-CRP/Alb ratio,hs-CRP and Alb concentration were 0.876,0.864 and 0.745,respectively.The predictive effi ciency of hs-CRP/Alb ratio was better than that of hs-CRP concentration or Alb concentration.Conclusions hs-CRP/Alb ratio has predictive value for the prognosis of patients with IHCA and the predictive value is superior to that of hs-CRP and Alb concentration.

关 键 词：院内心脏骤停 心肺复苏 自主循环恢复 心脏骤停后综合征 全身炎症反应综合征 血清白蛋白 高敏C反应蛋白 高敏C反应蛋白/血清白蛋白比值 

分 类 号：R459.7[医药卫生—急诊医学]