纤维蛋白原与白蛋白比值对成人体外膜肺氧合出血并发症的预测价值  

Predictive value of fibrinogen-albumin-ratio in adult hemorrhage after extracorporeal membrane oxygenation

作　　者：李凡[1] 赖巍[1] 姚华 康焰[1] LI Fan;LAI Wei;YAO Hua;KANG Yan(Department of Critical Care Medicine,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院重症医学科,成都610041

出　　处：《中国胸心血管外科临床杂志》2024年第9期1319-1326,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川大学华西医院学科卓越发展1·3·5工程项目(ZYGD18020)。

摘　　要：目的研究纤维蛋白原与白蛋白比值(fibrinogen-albumin-ratio,FAR)在成人体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)出血并发症中的临床价值。方法回顾性收集2018—2020年四川大学华西医院成人ECMO患者的临床资料。根据使用ECMO后是否出血,将患者分为出血组和未出血组。采用逻辑回归分析FAR与出血的关系、死亡的危险因素,使用受试者工作特征(receiver operating characteristic,ROC)曲线和曲线下面积(area under the curve,AUC)分析FAR的预测能力。根据预测出血并发症的FAR最佳截断值将患者分为高危组和低危组,比较两组患者出血的发生情况。结果共纳入125例患者,其中男85例、女40例,年龄46.00(31.50,55.50)岁。58例患者接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)治疗,67例患者接受静脉-静脉体外膜肺氧合(veno-venous extracorporeal membrane oxygenation,VV-ECMO)治疗。发生出血49例。与未出血组相比,出血组乳酸水平较高(P=0.026),上机前和上机24 h血小板计数较低(P=0.031、0.020),上机24 h纤维蛋白原水平较低(P=0.049),心肌炎患者比例更高(P=0.017)。ECMO支持模式亚组分析结果显示,VA-ECMO亚组较高的D-二聚体、全血乳酸和较低的上机前FAR、上机24 h FAR与出血相关(P=0.017、0.011、0.033、0.005)。上机24 h FAR与VA-ECMO患者出血独立相关(P=0.048),AUC为0.714,预测出血的最佳截断值为55.73;根据最佳截断值,高危组患者25例(≤55.73),低危组患者33例(>55.73)。与低危组相比,高危组出血发生率更高(未经调整P=0.002;多变量调整P=0.013)。VVECMO亚组FAR与出血无相关性(P均>0.05)。结论较低的上机24 h FAR是VA-ECMO患者出血的独立危险因素,诊断临界值为55.73。Objective To explore the clinical value of fibrinogen-albumin-ratio(FAR)in adult extracorporeal membrane oxygenation(ECMO)hemorrhage.Methods The clinical data of adult patients receiving ECMO in the West China Hospital from 2018 to 2020 were analyzed retrospectively.Patients were divided into a bleeding group and a nonbleeding group based on whether they experienced bleeding after ECMO.Logistic regression analysis was used to study the relationship between FAR and bleeding,as well as risk factors for death.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the predictive ability of FAR.According to the optimal cut-off value of FAR for predicting hemorrhage,patients were divided into a high-risk group and a low-risk group,and the occurrence of bleeding was compared between the two groups.Results A total of 125 patients were enrolled in this study,including 85 males and 40 females,aged 46.00(31.50,55.50)years.Among them,58 patients received veno-arterial extracorporeal membrane oxygenation(VA-ECMO)and 67 patients received veno-venous extracorporeal membrane oxygenation(VVECMO).There were 49 patients having bleeding,and the lactate level was higher(P=0.026),the platelet count before ECMO initiation and 24 h after ECMO initiation was lower(P=0.031,0.020),the fibrinogen level 24 h after ECMO initiation was lower(P=0.049),and the proportion of myocarditis patients was higher(P=0.017)in the bleeding group than those of the non-bleeding group.In the subgroup analysis of ECMO mode,the higher D-Dimer,lactate level and lower FAR before and 24 h after ECMO initiation were associated with bleeding in the VA-ECMO group(P=0.017,0.011,0.033,0.005).The 24 h FAR was independently correlated with bleeding(P=0.048),and AUC was 0.714.The cut-off value was 55.73.According to this optimal cut-off value,25 patients were divided into the high-risk group(≤55.73)and 33 into the low-risk group(>55.73).There was a higher incidence of bleeding in the high-risk group compared to the low-risk group(u

关 键 词：体外膜肺氧合 出血 纤维蛋白原 白蛋白 

分 类 号：R654.1[医药卫生—外科学]