LAR对ICU腹腔感染脓毒症患者院内死亡的预测价值  

Predictive value of LAR on in-hospital death of patients with intra-abdominal infection sepsis in ICU

作　　者：金鑫[1] 赵鸿雁[1] 苏善道 JIN Xin;ZHAO Hongyan;SU Shandao(Department of Intensive Care Medicine,Daqing Oilfield General Hospital,Daqing,Heilongjiang 163100,China)

机构地区：[1]大庆油田总医院重症医学科,黑龙江大庆163100

出　　处：《重庆医学》2024年第14期2159-2162,2167,共5页Chongqing medicine

基　　金：2022年度黑龙江省卫生健康委科技计划项目(20221717011022)。

摘　　要：目的探讨乳酸与白蛋白比值(LAR)对重症监护室(ICU)腹腔感染脓毒症患者院内死亡率的预测价值。方法回顾性分析2018年1月至2021年12月该院重症医学科收治的因腹腔感染引起脓毒症的175例患者临床资料,根据患者是否院内死亡分为生存组(n=94)和死亡组(n=81)。收集患者入院时一般资料及血乳酸和白蛋白水平并计算LAR,采用受试者工作特征(ROC)曲线评估LAR对于ICU脓毒症患者院内死亡率的预测价值,Cox回归分析和Kaplan-Meier曲线分析LAR与ICU死亡率之间的独立相关性。结果两组急性生理学与慢性健康状况量表Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、平均动脉压、氧合指数、降钙素原(PCT)、乳酸、白蛋白、LAR及手术患者比例比较,差异有统计学意义(P<0.05)。LAR预测ICU脓毒症休者预后的AUC为0.765(95%CI:0.695~0.835),高于APACHEⅡ评分、SOFA评分、乳酸、PCT,以LAR=1.295作为截断值,其预测的灵敏度和特异度分别为0.679、0.707。Kaplan-Meier曲线显示,高水平LAR(LAR≥1.295)的ICU死亡率高于低水平LAR(63.2%vs.41.5%),差异有统计学意义(P<0.05)。Cox回归分析结果显示,随着LAR水平升高,脓毒症死亡率呈升高趋势(P<0.05)。结论LAR是ICU腹腔感染脓毒症患者死亡的影响因素,可有效预测患者的院内死亡风险。Objective To investigate the predictive value of lactic acid to albumin ratio in the in-hospital mortality of the patients with intra-abdominal infection sepsis in ICU.Methods The clinical data in 175 patients with sepsis caused by intra-abdominal infection admitted and treated in the intensive care medicine department of this hospital from January 2018 to December 2021 were retrospectively analyzed.The patients were divided into the survival group(n=94)and death group(n=81)according to whether or not having in-hospital death.The general data,blood lactic acid and albumin levels of the patients at admission were collected,and the LAR value was calculated.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of LAR for the in-hospital mortality of sepsis patients in ICU.The Cox regression analysis and Kaplan-Meier curves were used to analyze the independent correlation between LAR and ICU mortality.Results There were statistically significant differences in the acute physiology and chronic health scoring systemⅡ(APACHⅡ)score,sequential organ failure assessment(SOFA)score,mean arterial pressure,oxygenation index,PCT,lactic acid,albumin,LAR and the proportion of surgical patients between the two groups(P<0.05).The area under the curve(AUC)of LAR for predicting the prognosis in the patients with ICU sepsis was 0.765(95%CI:0.695-0.835),which was higher than that of the APACHEⅡscore,SOFA score,lactic acid and PCT.With LAR=1.295 as the cutoff value,the sensitivity and specificity for its prediction were 0.679 and 0.707,respectively.The Kaplan-Meier curve showed that the ICU motality rate in high LAR(LAR≥1.29)was higher than that in low LAR,and the difference was statistically significant(63.2%vs.41.5%,P<0.05).The Cox regression analysis results showed that the mortality in s epsis showed the increasing trend with the LAR level increase(P<0.05).Conclusion LAR is an influencing factor of the death in the intra-abdominal infection sepsis in ICU,which could effectively predict the

关 键 词：乳酸与白蛋白比值 重症监护室 腹腔感染 脓毒症 预后 

分 类 号：R459.7[医药卫生—急诊医学]