白蛋白校正阴离子间隙对心脏骤停患者在院期间预后的预测价值  

Predictive value of albumin-corrected anion gap in in-hospital prognosis of patients with cardiac arrest

作　　者：李翱 虞连娇 郭海敏 LI Ao;YU Lianjiao;GUO Haimin(Department of Critical Care Medicine,the Second People's Hospital of Qinzhou,Qinzhou Guangxi 535000,China)

机构地区：[1]钦州市第二人民医院重症医学科,广西钦州535000

出　　处：《中国急救复苏与灾害医学杂志》2024年第10期1298-1301,1306,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2024年度自治区卫生健康西医类自筹经费科研科题(Z-N20241667)。

摘　　要：目的分析心脏骤停患者在院期间死亡的影响因素,并探讨白蛋白校正阴离子间隙(ACAG)对心脏骤停患者在院期间预后的预测价值。方法回顾2020年1月—2023年7月钦州市第二人民医院诊断为心脏骤停的ICU患者98例。根据在院期间是否死亡将患者分为死亡组和存活组。收集患者年龄、性别、序贯性器官功能衰竭(SOFA)评分及高血压、糖尿病等合并症患病情况,同时记录患者入ICU后第1次检查时血清白蛋白、Na^(+)、K^(+)、HCO_(3)^(-)、Cl^(-)等实验室检测结果。根据Na^(+)、K^(+)、HCO_(3)^(-)、Cl^(-)水平计算阴离子间隙(AG),然后计算ACAG,计算公式为ACAG=AG+[44-白蛋白(g/L)]×0.25。采用Logistic回归分析心脏骤停患者在院期间死亡的影响因素。绘制受试者工作特征(ROC)曲线,分析ACAG预测心脏骤停患者在院期间死亡的价值,并确定ACAG预测心脏骤停患者在院期间死亡的最佳截断值。结果死亡组患者年龄、SOFA评分明显高于存活组患者,差异有统计学意义(P<0.05)。死亡组患者白蛋白明显低于存活组患者,而AG、ACAG、血肌酐、血糖、血乳酸明显高于存活组患者,差异有统计学意义(P<0.05)。ACAG预测心脏骤停患者在院期间死亡最佳截断值为≥20.1 mmol/L,敏感度为86.0%,特异度为53.7%。年龄(OR=1.161,95%CI:1.003~1.343,P=0.045)、SOFA评分(OR=1.510,95%CI:1.017~2.240,P=0.041)、血乳酸(OR=11.383,95%CI:1.804~71.812,P=0.010)、ACAG≥20.1 mmol/L(OR=11.506,95%CI:3.092~42.814,P<0.001)是心脏骤停患者在院期间死亡的危险因素。结论高ACAG(≥20.1 mmol/L)是心脏骤停患者在院期间死亡的独立危险因素,且ACAG(≥20.1 mmol/L)预测心脏骤停患者在院期间死亡的敏感度较高。Objective To investigate the factors of in-hospital death in patients with cardiac arrest,and to investigate the predictive value of albumin-corrected anion gap(ACAG)in in-hospital prognosis of patients with cardiac arrest.Methods 98 ICU patients diagnosed with cardiac arrest in Qinzhou Second People's Hospital from January 2020 to July 2023 were reviewed.Patients were divided into death and survival groups according to whether they died while in hospital.Age,sex,SOFA score,hypertension,diabetes and other complications were collected.The laboratory test results of serum albumin,Na^(+),K^(+),HCO_(3)^(-),Cl^(-)were recorded during the first examination after admission to ICU.Firstly,the anion gap(AG)is calculated according to Na^(+),K^(+),HCO_(3)^(-),Cl^(-).ACAG was calculated using serum albumin and AG as ACAG=AG+(44-albumin[g/L])×0.25.Logistic regression analysis was used to find the factors of in-hospital death in patients with cardiac arrest.ROC curves were plotted to analyze the value of ACAG in predicting in-hospital death in patients with cardiac arrest,and to determine the optimal cutoff value for ACAG in predicting in-hospital death in patients with cardiac arrest.Results The age and SOFA scores of patients in the death group were significantly higher than those in the survival group,and the differences were statistically significant(P<0.05).In terms of laboratory examination,albumin in the death group was significantly lower than that in the survival group,while AG,ACAG,Cr,blood glucose and blood lactic acid were significantly higher than those in the survival group,with statistical significance(P<0.05).The optimal cut-off value of ACAG for predicting in-hospital death in patients with cardiac arrest was≥20.1 mmol/L,sensitivity was 86.0%,and specificity was 53.7%.Age(OR=1.161,95%CI:1.003-1.343,P=0.045),SOFA score(OR=1.510,95%CI:1.017-2.240,P=0.041),ACAG≥20.1 mmol/L(OR=11.506,95%CI:3.092-42.814,P<0.001)were risk factors for in-hospital death in patients with cardiac arrest.Conclusion High ACAG(≥20.1

关 键 词：白蛋白校正阴离子间隙 心脏骤停 重症监护病房 预后 

分 类 号：R459.7[医药卫生—急诊医学]