尿素氮与肌酐比值和血乳酸清除率对老年重症肺炎患者死亡风险的预测价值分析  

Urea nitrogen to creatinine ratio and blood lactate clearance rate in predicting the mortality risk of elderly with severe pneumonia

作　　者：高桂云 童凌 胡龙芳 Gao Guiyun;Tong Ling;Hu Longfang(Department of Respiratory and Critical Care Medicine,Lai’an Branch of Nanjing Drum Tower Hospital,Lai’an 239200,China)

机构地区：[1]南京鼓楼医院来安分院呼吸与危重症医学科,安徽来安239200 [2]南京鼓楼医院来安分院重症监护室,安徽来安239200

出　　处：《海军医学杂志》2024年第10期1095-1099,共5页Journal of Navy Medicine

摘　　要：目的分析尿素氮与肌酐比值(UCR)与血乳酸清除率(LCR)预测老年重症肺炎患者死亡风险的价值。方法选择南京鼓楼医院来安分院2018年5月至2022年3月呼吸重症监护室(RICU)收治的老年重症肺炎患者83例,收集患者临床资料,根据患者入院28 d的预后情况分为生存组(n=22)与死亡组(n=61)。分析老年重症肺炎患者死亡的危险因素,以及入院6 h UCR、LCR和二者联合对老年重症肺炎患者死亡风险的预测价值。结果死亡组入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、年龄、入院时肺炎严重指数(PSI)分级>3级病例数占比、入院6 h超敏C反应蛋白(hs-CRP)、中性粒细胞与淋巴细胞比值(NLR)、红细胞分布宽度(RDW)、白细胞(WBC)计数和UCR高于生存组(P<0.05),入院6 h LCR低于生存组(P<0.05)。入院时PSI分级>3级、入院6 h UCR升高、LCR降低为老年重症肺炎患者死亡的危险因素(P<0.05)。入院后6 h UCR与LCR及二者联合预测老年重症肺炎患者死亡风险的曲线下面积(AUC)分别为0.715、0.701和0.805(P<0.05)。结论入院时PSI分级>3级、入院6 h UCR升高、LCR降低是老年重症肺炎患者死亡的影响因素;入院6 h UCR与LCR可用于预测老年重症肺炎患者的死亡风险,二者联合对于老年重症肺炎患者的死亡风险预测价值更高。Objective To investigate the value of urea nitrogen to creatinine ratio(UCR)and blood lactate clearance rate(LCR)in predicting the mortality risk of elderly with severe pneumonia.Methods A total of 83 elderly patients with severe pneumonia who were admitted to the respiratory intensive care unit(RICU)of Lai’an Branch of Nanjing Drum Tower Hospital from May 2018 to March 2022 were enrolled in this study.The patients were divided into survival group(n=22)and death group(n=61)according to the prognosis on the 28th day after admission.The risk factors of death in elderly severe pneumonia were analyzed.The predictive value of UCR,LCR and the combination of them at 6 h after admission for the mortality risk of elderly patients with severe pneumonia was investigated.Results The Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score on admission,age,the proportion of patients with pneumonia severity index(PSI)grade>3 on admission,high-sensitivity C-reactive protein(hs-CRP)at 6 h after admission,neutrophil-to-lymphocyte ratio(NLR),red cell distribution width(RDW),white blood cell count(WBC),and UCR in the death group were higher than those in the survival group(P<0.05).The LCR at 6 h after admission in the death group was lower than that in the survival group(P<0.05).PSI grade>3 at admission,UCR increasing at 6 h after admission,and LCR decreasing at 6 h after admission were the risk factors for death in elderly patients with severe pneumonia(P<0.05).The area under the curve(AUC)values of UCR and LCR at 6 h after admission and their combination for the prediction of death in elderly patients with severe pneumonia were 0.715,0.701 and 0.805,respectively(P<0.05).Conclusion PSI grade>3 at admission,UCR increasing at 6 after admission,and LCR decreasing at 6 h after admission are risk factors for death in elderly patients with severe pneumonia.UCR and LCR at 6 h after admission can be used for predicting the mortality risk of elderly patients with severe pneumonia,and the combination of UCR and LCR has higher pre

关 键 词：尿素氮与肌酐比值 血乳酸清除率 老年患者 重症肺炎 死亡风险 预测价值 

分 类 号：R563[医药卫生—呼吸系统]