老年脓毒症患者血红蛋白水平与预后的关系--基于大型临床数据库MIMIC-Ⅳ的分析  

A nonlinear relationship between the hemoglobin level and prognosis of elderly patients with sepsis: an analysis based on MIMIC-Ⅳ

作　　者：杨朋磊 袁俊 陈齐红 於江泉[2] 郑瑞强[2] 于丽娜 袁周 张颖 仲文轩 马婷婷 丁喜珍 Yang Penglei;Yuan Jun;Chen Qihong;Yu Jiangquan;Zheng Ruiqiang;Yu Lina;Yuan Zhou;Zhang Ying;Zhong Wenxuan;Ma Tingting;Ding Xizhen(Department of Critical Care Medicine,Yangzhou University Affiliated Jiangdu People's Hospital,Yangzhou 225200,Jiangsu,China;Department of Critical Care Medicine,Northern Jiangsu People's Hospital,Yangzhou 225001,Jiangsu,China)

机构地区：[1]扬州大学附属江都人民医院重症医学科,江苏扬州225200 [2]江苏省苏北人民医院重症医学科,江苏扬州225001

出　　处：《中华危重病急救医学》2023年第6期573-577,共5页Chinese Critical Care Medicine

基　　金：江苏省卫生健康委医学科研项目(Z2022008);江苏省扬州市科技计划项目(YZ2021094)。

摘　　要：目的探讨老年脓毒症患者血红蛋白(Hb)水平与预后的关系。方法采用回顾性队列研究,提取美国重症监护医学信息数据库Ⅳ(MIMIC-Ⅳ)中老年脓毒症患者的相关数据,包括患者基本信息、血压、血常规〔Hb水平为患者入重症监护病房(ICU)前6 h至入ICU后24 h内最大值〕、血生化、凝血功能、生命体征、病情严重程度评分及结局指标。根据Cox回归分析,利用限制性立方样条模型绘制患者Hb水平与28 d死亡风险的关系曲线。根据关系曲线将患者分为Hb<100 g/L、100 g/L≤Hb<130 g/L、130 g/L≤Hb<150 g/L、Hb≥150 g/L 4组,分析各组患者的结局指标,并绘制28 d Kaplan-Meier生存曲线。采用Logistic回归模型及Cox回归模型分析不同Hb水平老年脓毒症患者的28 d死亡风险。结果共纳入7473例老年脓毒症患者。患者入ICU 24 h内Hb水平与28 d死亡风险呈"U"曲线关系,100 g/L≤Hb<130 g/L的患者28 d死亡风险较低;当Hb<100 g/L时,随着Hb水平升高患者死亡风险逐渐下降;当Hb≥130 g/L时,随着Hb水平升高患者死亡风险逐渐升高。多因素Logistic回归分析提示,在纳入所有混杂因素的模型中,Hb<100 g/L〔优势比(OR)=1.44,95%可信区间(95%CI)为1.23~1.70,P<0.001〕和Hb≥150 g/L(OR=1.77,95%CI为1.26~2.49,P=0.001)患者的死亡风险明显升高;130 g/L≤Hb<150 g/L时,患者死亡风险有升高趋势,但差异无统计学意义(OR=1.21,95%CI为0.99~1.48,P=0.057)。多因素Cox回归分析提示,在纳入所有混杂因素的模型中,Hb<100 g/L〔风险比(HR)=1.27,95%CI为1.12~1.44,P<0.001〕和Hb≥150 g/L(HR=1.49,95%CI为1.16~1.93,P=0.002)患者的死亡风险明显升高;130 g/L≤Hb<150 g/L时,患者死亡风险有升高趋势,但差异无统计学意义(HR=1.17,95%CI为0.99~1.37,P=0.053)。Kaplan-Meier生存曲线显示,100 g/L≤Hb<130 g/L组老年脓毒症患者28 d累积生存率明显高于Hb<100 g/L、130 g/L≤Hb<150 g/L和Hb≥150 g/L组(85.26%比77.33%、79.81%、74.33%;Log-Rank检验:χ2=71.850,Objective To investigate the correlation of hemoglobin(Hb)level with prognosis of elderly patients diagnosed as sepsis.Methods A retrospective cohort study was conducted.Information on the cases of elderly patients with sepsis in the Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ),including basic information,blood pressure,routine blood test results[the Hb level of a patient was defined as his/her maximum Hb level from 6 hours before admission to intensive care unit(ICU)and 24 hours after admission to ICU],blood biochemical indexes,coagulation function,vital signs,severity score and outcome indicators were extracted.The curves of Hb level vs.28-day mortality risk were developed by using the restricted cubic spline model based on the Cox regression analysis.The patients were divided into four groups(Hb<100 g/L,100 g/L≤Hb<130 g/L,130 g/L≤Hb<150 g/L,Hb≥150 g/L groups)based on these curves.The outcome indicators of patients in each group were analyzed,and the 28-day Kaplan-Meier survival curve was drawn.Logistic regression model and Cox regression model were used to analyze the relationship between Hb level and 28-day mortality risk in different groups.Results A total of 7473 elderly patients with sepsis were included.There was a"U"curve relationship between Hb levels within 24 hours after ICU admission and the risk of 28-day mortality in patients with sepsis.The patients with 100 g/L≤Hb<130 g/L had a lower risk of 28-day mortality.When Hb level was less than 100 g/L,the risk of death decreased gradually with the increase of Hb level.When Hb level was≥130 g/L,the risk of death gradually increased with the increase of Hb level.Multivariate Logistic regression analysis revealed that the mortality risks of patients with Hb<100 g/L[odds ratio(OR)=1.44,95%confidence interval(95%CI)was 1.23-1.70,P<0.001]and Hb≥150 g/L(OR=1.77,95%CI was 1.26-2.49,P=0.001)increased significantly in the model involving all confounding factors;the mortality risks of patients with 130 g/L≤Hb<150 g/L increased,while the

关 键 词：脓毒症 老年 血红蛋白 死亡风险 MIMIC-Ⅳ 

分 类 号：R459.7[医药卫生—急诊医学]