红细胞分布宽度与白蛋白比值和脓毒性休克患者预后的关系  

Relationship of red cell distribution width to albumin ratio with prognosis of patients with septic shock

作　　者：施秋凌 汪永斌[1] 钟磊 闵婕 姬晓伟[1] 谢波[1] SHI Qiuling;WANG Yongbin;ZHONG Lei;MIN Jie;JI Xiaowei;XIE Bo(Intensive Care Unit,Huzhou Central Hospital,Huzhou 313000,China;不详)

机构地区：[1]湖州市中心医院重症医学科,313000

出　　处：《浙江医学》2023年第13期1380-1383,1388,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2023KY311)。

摘　　要：目的 探讨红细胞分布宽度与白蛋白比值(RAR)和成人脓毒性休克(SS)患者预后的关系。方法 收集美国重症监护医学信息数据库(MIMIC-Ⅳ,v1.0版本)2008年至2019年收录的成人SS患者,研究结局为住院期间全因死亡率。按照患者住院期间预后情况分为存活组(1 642例)和死亡组(804例),比较两组患者基线临床特征。按照RAR值三分位数将患者分为低RAR组(RAR<0.522,812例)、中RAR组(RAR=0.522~0.660,817例)和高RAR组(RAR>0.660,817例),使用Kaplan-Meier法绘制3组住院期间累计生存率的生存曲线,并用log-rank检验予以分析。采用多因素Cox回归分析探讨RAR与患者预后的关系。结果 共纳入2 446例成人SS患者,住院期间全因死亡率为32.87%。与存活组相比,死亡组患者RAR显著升高(P<0.01)。生存曲线分析显示,随着入ICU时RAR下降,SS患者住院期间累计生存率逐渐升高,差异有统计学意义(P<0.01)。多因素Cox回归分析显示,高RAR是影响患者住院期间全因死亡率的独立危险因素(HR=1.365,95%CI:1.126~1.654)。结论 SS患者入ICU时高RAR水平(>0.660)与其住院期间全因死亡率有关,RAR可用于评估SS患者预后。Objective To investigate the relationship of red cell distribution width to albumin ratio(RAR)with the prognosis of adult patients with septic shock(SS).Methods Data of adult SS patients from 2008 to 2019 were obtained from Multiparameter Intelligent Monitoring in Intensive Care Ⅳ database(V.1.0).The primary endpoint was in-hospital all-cause mortality and the study population were divided into survival group(n=1642)and death group(n=804).Baseline characteristics for both groups were compared.RAR was measured at the first day of admission and the tertiles method is applied to divide the patients into three groups:low RAR group(<0.522,n=812),medium RAR group(0.522-0.660,n=817)and high RAR group(>0.660,n=817).The survival curve of the in-hospital cumulative survival rate was draw through the Kaplan-Meier method,and was tested by the log-rank test.The relationship between RAR and the prognosis of these patients was analyzed by the multivariate Cox regression analysis.Results A total of 2446 adult SS patients were included in the study and the allcause mortality rate dring hospitalization was 32.87%.The value of RAR was significantly higher in the death group than that in the survival group(P<0.01).Kaplan-Meier curve showed that the in-hospital cumulative survival rate of SS patients increased with the decrease of RAR(P<0.01).Multivariate Cox regression analysis demonstrated that increased RAR is an independent risk factor for in-hospital all-cause mortality(HR=1.365,95%CI:1.126-1.654).Conclusion Elevated RAR(>0.660)at admission to the intensive care unit is associated with in-hospital all-cause mortality,indicating that RAR might be used to assess the prognosis of SS patients.

关 键 词：红细胞分布宽度与白蛋白比值 脓毒性休克 预后 

分 类 号：R459.7[医药卫生—急诊医学]