血尿素氮与白蛋白比值对急诊脓毒症患者预后的评估价值  

The prognostic value of blood urea nitrogen to albumin ratio in patients with sepsis in the emergency department

作　　者：张莹[1] 王军宇[1] 魏兵[1] 胡乐[1] 王嘉 董红锰 姬文卿 武军元[1] Zhang Ying;Wang Junyu;Wei Bing;Hu Le;Wang Jia;Dong Hongmeng;Ji Wenqing;Wu Junyuan(Emergency Medical Center,Beijing Chao-Yang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Clinical Center for Medicine in Acute Infection,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊医学中心、心肺脑复苏北京市重点实验室、首都医科大学急性感染临床诊疗与研究中心,北京100043

出　　处：《中国医药》2024年第7期1028-1032,共5页China Medicine

基　　金：北京市科技计划(Z211100002921061)。

摘　　要：目的探讨血尿素氮与白蛋白比值(BAR)对急诊脓毒症患者预后的评估价值。方法本研究采用回顾性观察的研究方法,收集了2021年3月至2022年3月在首都医科大学附属北京朝阳医院急诊抢救室治疗的313例脓毒症患者的基本信息和实验室检查数据。根据在院治疗期间是否死亡将患者分为存活组(229例)和死亡组(84例)。比较2组患者临床和实验室检查资料,分析患者住院期间死亡的危险因素。采用受试者工作特征(ROC)曲线评价BAR对脓毒症患者预后的评估价值。结果死亡组年龄、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、心率、脑梗死比例明显高于存活组,收缩压、舒张压、慢性阻塞性肺疾病比例低于存活组,差异均有统计学意义(均P<0.05)。死亡组白细胞计数、中性粒细胞绝对值、C反应蛋白、降钙素原、血尿素氮、天冬氨酸转氨酶、BAR高于存活组,淋巴细胞绝对值、白蛋白水平低于存活组(均P<0.05)。多因素Logistic回归分析结果显示,BAR(P=0.025)、APACHEⅡ评分(P<0.001)是脓毒症患者住院期间死亡的独立危险因素。ROC曲线分析结果显示,BAR预测脓毒症患者住院期间死亡的曲线下面积(AUC)为0.728,APACHEⅡ评分的AUC为0.814,BAR+APACHEⅡ评分的AUC为0.824,联合预测效果优于单独应用BAR。BAR与APACHEⅡ评分联合预测时可以获得较好的敏感度和特异度(敏感度为77.4%,特异度为75.5%)。结论BAR、APACHEⅡ评分是脓毒症患者预后的独立危险因素。BAR对急诊脓毒症患者预后具有中等的预测能力,特异度较高。与单独应用BAR相比,BAR联合APACHEⅡ评分具有更好的预测能力,其敏感度更好,同时具有较高的特异度。Objective To explore the prognostic value of blood urea nitrogen to albumin ratio in patients with sepsis in the emergency department.Methods The basic information and laboratory examination data of 313 patients with sepsis treated in the emergency room of Beijing Chao-Yang Hospital,Capital Medical University from March 2021 to March 2022 were collected by retrospective observation method.The patients were divided into survival group(229 cases)and death group(84 cases)according to whether they died during the treatment in the hospital.The clinical and laboratory data of the two groups were compared,and the risk factors of death during hospitalization were analyzed.Receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of BAR in patients with sepsis.Results The age,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,heart rate,and proportion of cerebral infarction in the death group were significantly higher than those in the survival group,while systolic blood pressure,diastolic blood pressure,and proportion of chronic obstructive pulmonary diseasein the death group were lower than those in the survival group(all P<0.05).The white blood cell count,absolute value of neutrophils,CRP,procalcitonin,blood urea nitrogen,aspartate aminotransferase,and BAR in the death group were higher than those in the survival group,while the absolute value of lymphocytes and albumin levels were lower than those in the survival group(all P<0.05).Multivariate Logistic regression analysis showed that BAR(P=0.025)and APACHEⅡ score(P<0.001)were independent risk factors for in-hospital death of sepsis patients.The ROC curve analysis results showed that the area under the curve(AUC)of BAR for predicting the death of sepsis patients during hospitalization was 0.728,the AUC for APACHEⅡ score was 0.814,and the AUC for BAR+APACHEⅡ score was 0.824.The combined predictive effect was better than BAR alone.The combination of BAR and APACHEⅡ scores had good sensitivity and specificity(sensitivity

关 键 词：脓毒症 血尿素氮 白蛋白 预后 

分 类 号：R631[医药卫生—外科学]