国际标准化比值与急性呼吸窘迫综合征患者住院病死率的关系  

Association between international normalized ratio and in-hospital case fatality rate in patients with acute respiratory distress syndrome

作　　者：韦倩清 廖林[1] 林发全[1] WEI Qianqing;LIAO Lin;LIN Faquan(Department of Clinical Laboratory,the First Affiliated Hospital of Guangxi Medical University/Key Laboratory for Diagnostics of Clinical Laboratory Medicine of the Guangxi Universities,Nanning 530021,Guangxi,China;Department of Clinical Laboratory,Hengzhou People's Hospital,Hengzhou 530300,Guangxi,China)

机构地区：[1]广西医科大学第一附属医院检验科/广西高校临床检验诊断学重点实验室,广西南宁530021 [2]广西横州市人民医院检验科,广西横州530300

出　　处：《右江医学》2024年第11期972-978,共7页Chinese Youjiang Medical Journal

基　　金：广西高校中青年教师科研基础能力提升项目(2024KY0098)。

摘　　要：目的基于真实世界的大规模临床数据库探究国际标准化比值(INR)与急性呼吸窘迫综合征(ARDS)患者住院病死率之间的关系。方法研究以来自美国重症监护数据库(MIMIC-IV)中符合2012年柏林定义的ARDS患者为研究对象,依据其入ICU后24小时内INR值以三分位数方法分为三组,分别为:Q1组(INR<1.2),Q2组(1.2≤INR<1.6),Q3组(INR≥1.6)。采用logistic多因素回归模型和限制性立方样条分析评估INR和ARDS患者住院病死率之间的相关性,并进一步进行亚组和交互作用分析。结果共有760例患者被纳入研究,平均年龄为(60.1±17.3)岁,其中54.1%为男性。INR水平与ARDS患者住院病死率有关(P<0.001),Q3组(INR≥1.6)与住院病死率增加明显相关(OR=2.46,95%CI 1.5~4.01,P<0.001),在调整全部协变量后,效应值仍显著(OR=2.22,95%CI 1.28~3.84,P<0.05)。限制性立方样条分析发现,INR水平与ARDS患者住院病死率之间呈线性关系(P>0.05)。亚组分析显示,INR水平在年龄、性别、ARDS严重程度、是否合并心肌梗死及是否合并糖尿病亚组之间无显著交互作用(P>0.05)。结论INR水平与ARDS患者住院病死率呈线性关系,高INR水平与住院病死率升高有关。Objective To explore relationship between international normalized ratio(INR)and in-hospital case fatality rate in patients with acute respiratory distress syndrome(ARDS)based on a large-scale clinical database in the real world.Methods In this study,ARDS patients who met 2012 Berlin definition from the Medical Information Mart for Intensive Care IV(MIMIC-IV)of American intensive care database were selected as research objects.According to their INR values within 24 hours of admission to the ICU,they were divided into three groups by third quartile method,namely:Q1 group(INR<1.2),Q2 group(1.2≤INR<1.6),and Q3 group(INR≥1.6).Multivariate logistic regression models and restricted cubic splines were used to evaluate correlation between INR and in-hospital case fatality rate in ARDS patients.And subgroups and interactions were further analyzed.Results A total of 760 patients were included in the study,with an average age of(60.1±17.3)years,of which 54.1%were male.The level of INR was related to the in-hospital case fatality rate of ARDS patients(P<0.001),and the Q3 group(INR≥1.6)was significantly correlated with an increase in in-hospital case fatality rate(OR=2.46,95%CI 1.5-4.01,P<0.001).After adjusting for all covariates,the effect value was still significant(OR=2.22,95%CI 1.28-3.84,P<0.05).Restrictive cubic spline analysis found a linear relationship between INR levels and in-hospital case fatality rate in ARDS patients(P>0.05).Subgroup analysis showed that there was no significant interaction between INR level and age,gender,ARDS severity,and whether myocardial infarction and diabetes were combined(P>0.05).Conclusion INR level shows a linear correlation of the in-hospital case fatality rate in ARDS patients,and high INR level is associated with increased in-hospital case fatality rate.

关 键 词：国际标准化比值 急性呼吸窘迫综合征 住院病死率 MIMIC-IV 

分 类 号：R563.8[医药卫生—呼吸系统]