血尿素氮与白蛋白比值对重症急性胰腺炎患者28 d预后的预测价值 ——一项基于MIMIC-Ⅲ数据库的回顾性队列研究  

Predictive value of blood urea nitrogen/albumin ratio for 28-day prognosis in patients with severe acute pancreatitis:aretrospective cohort study based on MIMIc-Ⅲ database

作　　者：张云[1,2] 朱瑾 刘欢 王双乐[1,2] 胡星星 倪海滨 Zhang Yun;Zhu Jin;Liu Huan;Wang Shuangle;Hu Xingxing;NI Haibin(Department of Emergeney,Afiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210000,Jiangsu,China;Jiangsu Province Academy of Traditional Chinese Medicine,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京中医药大学附属中西医结合医院急诊科,江苏南京210000 [2]江苏省中医药研究院,江苏南京210000

出　　处：《中国中西医结合急救杂志》2022年第3期315-319,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省医药卫生科研项目(ZDB2020032)。

摘　　要：目的 探讨血尿素氮/白蛋白比值(BAR)对重症急性胰腺炎(SAP)患者28 d预后的预测价值.方法 采用回顾性队列研究方法,提取美国重症监护医学信息数据库-Ⅲ(MIMIC-Ⅲ)中SAP患者的临床数据.计算SAP患者入住重症监护病房(ICU)1 d的BAR,比较不同预后SAP患者临床特征的差异;采用逻辑回归模型筛选出影响SAP患者住院死亡的独立危险因素;绘制受试者工作特征曲线(ROC曲线),并根据ROC曲线得出的最佳截断值对SAP患者28 d死亡进行亚组分析;采用Cox风险回归模型探讨BAR对SAP患者28 d死亡的影响,并绘制Kaplan-Meier生存曲线.结果 共纳入586例SAP患者,生存组505例,死亡组81例.死亡组年龄、急性生理学评分Ⅲ(APSⅢ)评分、全身炎症反应综合征(SIRS)评分、序贯器官衰竭评分(SOFA)、白细胞计数(WBC)、尿素氮(BUN)、肌酐(Cr)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、国际标准化比值(INR)、天冬氨酸转氨酶(AST)、肾脏替代治疗、使用血管活性药物、机械通气和BAR均明显高于生存组,ICU住院时间较生存组明显延长;而体温、平均动脉压(MAP)、血小板计数(PLT)、pH值、碳酸氢盐、白蛋白(Alb)均明显低于生存组(均P<0.05).与BAR<0.85相比,单因素和多因素回归分析显示,BAR≥0.85是影响SAP死亡的独立危险因素〔优势比(OR)和95%可信区间(95%CI)分别为5.47(2.90~10.31)和3.99(1.59~10.00),P值分别为<0.001和0.003).ROC曲线分析显示,BAR预测SAP患者28 d预后的ROC曲线下面积(AUC)=0.711,95%CI为0.642~0.780,依据最大约登指数计算出的BAR截断值为0.85;与BAR<0.85相比,单因素和多因素Cox比例风险回归分析显示,BAR≥0.85的SAP患者28 d死亡风险增加〔风险比(HR)和95%CI分别为5.04(2.74~9.29)和3.15(1.39~7.14),P值分别为<0.001和0.006).Kaplan-Meier生存曲线显示,BAR<0.85 SAP患者的28 d累积生存率明显高于BAR≥0.85者(Log-Rank检验:χ^(2)=32.867,P<0.001).结论 BAR对SAP患者28 d预后�Objective To investigate the predictive value of blood urea nitrogen/albumin ratio(BAR)for 28-day in patients with severe acute pancreatitis(SAP).Methods A retrospective cohort study was conducted to extract clinical data of SAP patients from the database of American Medical Information Mart for Intensive Care-II(MIMIC-II).The BAR of SAP patients on the first day after admission to the intensive care unit(ICU)was calculated,and the differences in clinical characteristics between dfferent outcomes of SAP patients,survival and death groups,were compared;Logistic regression model was used to screen out the independent rsk factors that might affect SAP patients'in-hospital mortality;the receiver operator characteristic curve(ROC curve)was drawn and based on the best cut-offvalue obtained from the ROC curve to analyze the subgroups of 28-day deaths in SAP patients;the Cox risk regression model was used to investigate the effect of BAR on 28-day death in SAP patients,and Kaplan-Meier survival curves were drawn.Results A total of 586 patients with SAP were enrolled,505 in the survival group and 81 in the death group.The age,acute physiology scoreⅢ(APS Ⅲ),systemic inflammatory response syndrome(SIRS)score,sequential organ failure assessment(SOFA)score,white blood cells count(WBC),blood urea nitrogen(BUN),creatinine(Cr),prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR),aspartate aminotransferase(AST),renal replacement therapy,use of vasoactive drug,use of mechanical ventilation and BAR in the death group were significantly higher than those in the survival group,and the length of ICU stay in the death group was also significantly longer than that in the survival group;while the body temperature,mean arterial pressure(MAP),platelet count(PLT),pH value,bicarbonate and albumin(Alb)in the death group were all significantly lower than those in the survival group(all P<0.05).Compared with BAR<0.85,univariate and multivariate regression analyses showed that BAR≥0.85 was an

关 键 词：重症急性胰腺炎 血尿素氮/白蛋白比值 预后 

分 类 号：R459.7[医药卫生—急诊医学]