血红蛋白-白蛋白-淋巴细胞-血小板指数对AECOPD患者ICU病死率的预测效果  

Predictive value of hemoglobin-albumin-lymphocyte-platelet index on mortality in ICU during acute exacerbation of chronic obstructive pulmonary disease

作　　者：姚欢 钱宇杰 张洁如 YAO Huan;QIAN Yujie;ZHANG Jieru(Department of Respiratory Medicine,the Fifth People's Hospital of Zhangjiagang,Zhangjiagang Jiangsu 215600,China)

机构地区：[1]张家港市第五人民医院呼吸内科,江苏张家港215600 [2]张家港市第一人民医院呼吸内科,江苏张家港215600

出　　处：《中国急救复苏与灾害医学杂志》2024年第9期1178-1182,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2023年度江苏省老年科研项目(编号:LK2023038)。

摘　　要：目的评估血红蛋白-白蛋白-淋巴细胞-血小板(HALP)指数对慢性阻塞性肺病急性加重期(AECOPD)患者ICU病死率的预测价值。方法回顾2021年8月—2022年11月就诊于张家港市第五人民医院明确诊断为AECOPD的患者共计138例。收集患者的一般资料、病史、生命体征和实验室数据。结局指标为患者在ICU内死亡情况。使用Cox比例风险模型评估HALP指数对AECOPD患者ICU病死率的预测价值。绘制HALP指数预测ICU病死率的受试者工作特征(ROC)曲线,并计算ROC曲线下面积(AUC)。依据ROC曲线计算HALP指数的最大约登指数所对应的灵敏度及特异度。通过ROC曲线确定HALP指数的最佳截断值,依照最佳截断值进行分组,绘制Kaplan-Meier曲线比较组间生存情况。结果所观察138例患者中,有21例患者在ICU内死亡,病死率为15.2%。依照是否死亡进行分组,结果显示死亡组患者年龄,冠心病患病率,肌肝(Cr)、尿素氮(BUN)、K+明显高于存活组患者,差异有统计学意义(P<0.05);SBP、白蛋白、淋巴细胞计数、HALP指数明显低于存活组患者,差异有统计学意义(P<0.05)。Cox比例风险模型结果显示,年龄的升高与ICU病死率呈明显正相关(P=0.023,HR=1.199,95%CI:1.026~1.402)。HALP指数的升高与ICU病死率呈明显负相关(P=0.007,HR=0.762,95%CI:0.626~0.927)。HALP指数预测AECOPD患者ICU病死率的AUC为0.901,最大约登指数为0.734,敏感度为90.5%,特异度为82.9%。HALP指数的最佳截断值为15.75。依照HALP指数>15.75和≤15.75进行分组,结果显示两组总体存活时间分布差异具有统计学意义(χ^(2)=50.85,P<0.001)。结论HALP指数的降低与AECOPD患者ICU病死率增加呈明显正相关,提示HALP指数能够作为AECOPD患者预后的预测因子。Objective To evaluate the predictive value of hemoglobin-albumin-lymphocyte-platelet(HALP)index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods A total of 138 patients diagnosed with AECOPD in our hospital from August 2021 to November 2022 were reviewed.General information,medical history,vital signs,and laboratory data were collected.The outcome was death in the ICU.The predictive value of HALP index for ICU mortality in patients with AECOPD was evaluated by Cox proportional risk model.the receiver operating characteristic curve(ROC curve)of HALP index predicting ICU mortality was plotted,and the area under the ROC curve was calculated.AUC.The sensitivity and specificity corresponding to the maximum Youden index of HALP index were calculated according to ROC curve.The optimal cut-off value of HALP index was determined by ROC curve,and groups were grouped according to the optimal cut-off value.Kaplan-Meier curve was drawn to compare survival among groups.Results Of the 138 patients observed,21 died in the ICU,with mortality of 15.2%.They are grouped according to death or not.The results showed that the age of patients in the death group was significantly higher than that in the survival group,and the difference was statistically significant(P<0.05).The prevalence of coronary heart disease in death group was significantly higher than that in survival group,and the difference was statistically significant(P<0.05).The SBP of death group was significantly lower than that of survival group,and the difference was statistically significant(P<0.05).Cr,BUN,K+in death group were significantly higher than those in survival group,albumin,lymphocyte count was significantly lower than those in survival group,the difference was statistically significant(P<0.05).HALP index in death group was significantly lower than that in survival group,with statistical significance(P<0.05).Cox proportional risk model showed that the increase of age was positively correlated with

关 键 词：血红蛋白-白蛋白-淋巴细胞-血小板指数 慢性阻塞性肺疾病急性加重期 ICU病死率 预后 

分 类 号：R563.19[医药卫生—呼吸系统]