年龄校正查尔森合并症指数联合尿酸与恶性肿瘤合并肺栓塞住院全因死亡的相关性分析  

Correlation between the Combination of Age-Adjusted Charlson Comorbidity Index and Uric Acid and the All-Cause Mortality in Inpatients with Malignant Tumor and Pulmonary Embolism

作　　者：伍家利 滕湘楠 廖静 徐珊玲[2] Wu Jiali;Teng Xiangnan;Liao Jing;Xu Shanling(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Critical Care Medicine,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]西南医科大学附属医院呼吸与危重症医学科,四川泸州646000 [2]四川省肿瘤临床医学研究中心,四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院重症医学科,成都610041

出　　处：《肿瘤预防与治疗》2023年第5期389-398,共10页Journal of Cancer Control And Treatment

基　　金：四川省临床重点专科建设项目。

摘　　要：目的:调查恶性肿瘤合并肺栓塞患者的临床特征及住院期间全因死亡相关危险因素,同时探讨年龄校正查尔森合并症指数(age-adjusted Charson comorbidity index, ACCI)联合尿酸与不良预后的相关性。方法:回顾性分析2017年1月至2022年6月于四川省肿瘤医院诊断的恶性肿瘤合并肺栓塞患者的临床资料,根据患者住院期间是否死亡分为死亡组和存活组。通过单因素及多因素Logistic回归模型分析探讨患者死亡危险因素,采用ROC曲线及曲线下面积分析ACCI及尿酸对恶性肿瘤合并肺栓塞患者住院期间全因死亡的预测价值。结果:纳入253例恶性肿瘤合并肺栓塞的患者,20例(7.9%)住院期间死亡。单因素分析结果显示近期感染、高危肺栓塞、溶栓治疗、远处转移与患者住院期间死亡相关(P <0.05);死亡组呼吸、脉搏、白细胞、中性粒细胞计数、D-二聚体、凝血酶原时间、活化部分凝血酶时间、总胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、尿素氮、尿酸、ACCI评分明显高于存活组(P <0.05),死亡组收缩压、白蛋白明显低于存活组(P <0.05)。多因素Logistic回归分析显示ACCI评分(OR=1.649, P=0.006)、白细胞计数(OR=1.099,P=0.045)、尿酸(OR=1.007,P <0.001)和近期感染(OR=4.953, P=0.035)是恶性肿瘤合并肺栓塞患者住院死亡的独立危险因素;收缩压(OR=0.957, P <0.001)是恶性肿瘤合并肺栓塞患者住院死亡的保护因素。ROC曲线结果显示,ACCI、尿酸水平及两者联合预测恶性肿瘤合并肺栓塞住院死亡的曲线下面积分别为0.714(0.597~0.832)、0.712(0.573~0.851)和0.828(0.714~0.915),以两者联合预测住院死亡的AUC值最大。结论:ACCI、白细胞计数、尿酸和近期感染是恶性肿瘤合并肺栓塞患者住院期间全因死亡的独立危险因素,收缩压是其保护因素。ACCI联合血清尿酸水平可以提高预测恶性肿瘤合并肺栓塞住院死亡的准确性。Objective:To investigate the risk factors of all-cause mortality in and the clinical features of inpatients with malig-nant tumor complicated with pulmonary embolism,and explore the correlation between age-adjusted Charlson comorbidity index(ACCI)and poor prognosis.Methods:Clinical data of patients diagnosed as malignant tumors complicated with pulmonary em-bolism from Sichuan Cancer Hospital from January 2017 to June 2018 were retrospectively analyzed.The patients were classified into the death group and the survival group according to whether they died during hospitalization.Univariate and multivariate logistic regression analyses were performed to identify the death-related risk factors in these patients.Receiver operating charac-teristic(ROC)curve and area under the curve(AUC)were used to analyze the values of ACCI and uric acid in predicting the all-cause mortality in patients with pulmonary embolism and cancer.Results:253 patients with malignant tumor complicated with pulmonary embolism were included in this study,20 patients(7.9%)died during hospitalization.Univariate analysis showed that recent infections,high-risk pulmonary embolism,thrombolytic therapy and distant metastasis were correlated to in-hospital death of patients(P<0.05);the levels of respiration,pulse,white blood cells,neutrophils,D-dimer,prothrombin time,activated partial thrombin time,total bilirubin,alanine aminotransferase,aspartate aminotransferase,albumin,blood urea nitrogen,uric acid and the ACCI score in the death group were significantly higher than those in the survival group(P<O.05),and the systolic blood pressure and albumin in the death group was significantly lower than that in the survival group(P<0.05).Multivariate logistic regression analysis showed that ACCI score(OR=1.649,P=0.006),white blood cell count(OR=1.099,P=0.045),uric acid(OR=1.007,P<0.001)and recent infection(OR=4.953,P=0.035)were independent risk factors of all-cause mortality in these patients;systolic blood pressure(OR=0.957,P<0.001)was a protective factor of al

关 键 词：肺栓塞 癌 危险因素 年龄校正查尔森合并症指数 

分 类 号：R563.5[医药卫生—呼吸系统] R73[医药卫生—内科学]