血糖/淋巴细胞比值与脓毒症相关急性肾损伤患者预后的关系  

Association between blood glucose-to-lymphocyte ratio and prognosis of patients with sepsis-associated acute kidney injury

作　　者：张丽华 刘芬[1] 李祺 李洋[2] 邵强[1] 陶文强 胡萍 钱克俭[1] 卢院华 Zhang Lihua;Liu Fen;Li Qi;Li Yang;Shao Qiang;Tao Wenqiang;Hu Ping;Qian Kejian;Lu Yuanhua(Department of Critical Care Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi,China;Jiangxi Medical Center for Critical Public Health Events,the First Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi,China)

机构地区：[1]南昌大学第一附属医院重症医学科,江西南昌330006 [2]南昌大学第一附属医院江西省重大公共卫生事件医学中心,江西南昌330006

出　　处：《中华危重病急救医学》2023年第12期1262-1267,共6页Chinese Critical Care Medicine

基　　金：江西省自然科学基金(20232BAB206083)。

摘　　要：目的探讨血糖/淋巴细胞比值(GLR)与脓毒症相关急性肾损伤(SA-AKI)患者预后的关系。方法基于美国重症监护医疗信息数据库-Ⅳ(MIMIC-Ⅳ),选择年龄≥18岁的SA-AKI患者。根据GLR三分位数将SA-AKI患者分为GLR1组(GLR≤4.97×10^(-9)mmol)、GLR2组(4.97×10^(-9)mmol<GLR<9.75×10^(-9)mmol)、GLR3组(GLR≥9.75×10^(-9)mmol);此外根据入院后28 d预后将SA-AKI患者分为生存组和死亡组。提取患者性别、年龄、生命体征、入院首次实验室检验结果、合并症、序贯器官衰竭评分(SOFA)、急性生理学评分Ⅲ(APSⅢ)以及治疗措施等指标,采用Kaplan-Meier生存分析SA-AKI患者28 d、90 d、180 d和1年生存情况,采用多因素Logistic回归分析SA-AKI患者28 d病死率的独立危险因素,采用受试者工作特征曲线(ROC曲线)分析GLR对SA-AKI患者预后的预测效能。结果共纳入1524例SA-AKI患者,中位年龄为68.28(58.96,77.24)岁;女性612例(40.16%),男性912例(59.84%);GLR1组507例,GLR2组509例,GLR3组508例;28 d生存组1181例,死亡组343例。按照GLR三分位数分组显示,随着GLR的升高,SA-AKI患者28 d、90 d、180 d和1年病死率均逐渐升高(28 d病死率分别为11.64%、22.00%、33.86%,90 d病死率分别为15.98%、26.72%、40.55%,180 d病死率分别为17.16%、28.29%、41.73%,1年病死率分别为17.95%、29.27%、42.72%,均P<0.01)。根据28 d生存状态分组,死亡组患者GLR明显高于生存组〔×10^(-9)mmol:9.81(5.75,20.01)比6.44(3.64,10.78),P<0.01〕。多因素Logistic回归分析显示,GLR是SA-AKI患者28 d病死率的独立危险因素〔GLR作为连续性变量时:优势比(OR)=1.065,95%可信区间(95%CI)为1.045~1.085,P<0.001;GLR作为分类变量时,相对于GLR1组:GLR2组OR=1.782,95%CI为1.200~2.647,P=0.004,GLR3组OR=2.727,95%CI为1.857~4.005,P<0.001〕。ROC曲线分析显示,GLR预测SA-AKI患者28 d病死率的曲线下面积(AUC)为0.674,最佳截断值为8.769×10^(-9)mmol时,敏感度为57.1%,特异度为67.1%;将GLR与APSⅢ评分和SOFA�Objective To investigate the association between the glucose-to-lymphocyte ratio(GLR)and prognosis of patients with sepsis-associated acute kidney injury(SA-AKI).Methods Based on the Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ),SA-AKI patients aged≥18 years were selected.According to the tertiles of GLR,the patients were divided into GLR1 group(GLR≤4.97×10^(-9)mmol),GLR2 group(4.97×10^(-9)mmol<GLR<9.75×10^(-9)mmol)and GLR3 group(GLR≥9.75×10^(-9)mmol).Patients with SA-AKI were divided into survival group and death group according to whether they survived 28 days after admission.The patient's gender,age,vital signs,laboratory test results,comorbidities,sequential organ failure assessment(SOFA),acute physiology scoreⅢ(APSⅢ)score and treatment measures were extracted from the database.Kaplan-Meier survival analysis was used to make the survival curves of patients with SA-AKI at 28 days,90 days,180 days and 1 year.Multivariate Logistic regression analysis model was used to explore the independent risk factors of 28-day mortality in patients with SA-AKI.Receiver operator characteristic curve(ROC curve)was used to analyze the predictive efficacy of GLR for the prognosis of patients with SA-AKI.Results A total of 1524 patients with SA-AKI were included,with a median age of 68.28(58.96,77.24)years old,including 612 females(40.16%)and 912 males(59.84%).There were 507 patients in the GLR1 group,509 patients in the GLR2 group and 508 patients in the GLR3 group.There were 1181 patients in the 28-day survival group and 343 patients in the death group.Grouping according to GLR tertiles showed that with the increase of GLR,the 28-day,90-day,180-day and 1-year mortality of SA-AKI patients gradually increased(28-day mortality were 11.64%,22.00%,33.86%,respectively;90-day mortality were 15.98%,26.72%,40.55%,respectively;180-day mortality were 17.16%,28.29%and 41.73%,and the 1-year mortality were 17.95%,29.27%and 42.72%,respectively,all P<0.01).According to 28-day survival status,the GLR of the death grou

关 键 词：脓毒症相关急性肾损伤 血糖/淋巴细胞比值 预后 

分 类 号：R459.7[医药卫生—急诊医学] R692.5[医药卫生—治疗学]