血清尿素氮水平对重症监护室脓毒症患者住院期间死亡风险的预测价值研究  

Predictive value of serum blood urea nitrogen levels for in-hospital mortality risk among sepsis patients in the intensive care unit

作　　者：范铭炎 徐平[1,2] 吕禄楷 雷玲 钟志涛[1,2] FAN Mingyan;XU Ping;LV Lukai;LEI Ling;ZHONG Zhitao(Department of Emergency,Zigong Fourth People's Hospital,Zigong,Sichuan,643000,China;Medical Big Data and Artificial Intelligence Laboratory of Zigong Fourth People's Hospital;Department of Intensive Care Unit,Zigong Fourth People's Hospital)

机构地区：[1]自贡市第四人民医院急诊科,四川自贡643000 [2]自贡市医学大数据与人工智能研究院医学大数据研究所 [3]自贡市第四人民医院重症医学科

出　　处：《临床急诊杂志》2025年第1期55-60,共6页Journal of Clinical Emergency

基　　金：四川省科技厅科技创新平台(基地)和人才计划(No:2024JDKP0021);四川省医学科研课题计划(No:S21019);四川省中医药管理局科学技术研究专项课题(No:2023MS494);自贡市科学技术局重点科技计划项目(No:2022ZCYGY05、2023-YGY-3-04、2022ZCYGY24、2022ZCYKY08);自贡市卫生健康委员会卫生健康科研课题(No:22zd004、22yb024)。

摘　　要：目的:探讨血清尿素氮(blood urea nitrogen,BUN)水平对重症监护室脓毒症患者住院期间死亡风险的预测价值。方法:本研究为单中心、回顾性研究,纳入2018-2023年自贡市第四人民医院重症监护室收治的符合纳入标准的404例脓毒症患者。收集人口学特征、评分、实验室检查及干预措施等资料。将患者按入院时BUN中位数分为高、低BUN组,分析基线资料差异,并以住院期间死亡为终点,采用logistic回归分析探讨BUN与死亡风险的关系。利用限制性立方样条探讨BUN与住院期间全因死亡的剂量反应关系,绘制ROC曲线评估BUN、序贯性器官衰竭(sequential organ failure assessment,SOFA)评分及两者联合预测效果。结果:404例患者中,男性占63.12%,平均年龄为74.5岁,住院期间病死率为31.93%。高BUN组住院期间病死率(43.84%)显著高于低BUN组(19.90%)。多因素logistic回归分析显示,BUN(OR=1.045,95%CI:1.014~1.077,P=0.004)和SOFA评分(OR=1.267,95%CI:1.176~1.365,P<0.001)是住院期间死亡的独立危险因素。限制性立方样条分析表明,BUN与死亡风险呈非线性关系:当BUN<5.563 mmol/L时具有保护作用,BUN高于该值后,死亡风险随之增加。BUN联合SOFA的AUC为0.732(0.676,0.732),高于单独的BUN、SOFA评分的预测效能。结论:BUN水平与ICU脓毒症患者住院期间死亡风险存在显著关联,BUN有助于提升SOFA评分对ICU脓毒症院内死亡的预测效能,为临床决策提供依据。Objective:To investigate the predictive value of serum blood urea nitrogen(BUN)levels for in-hospital mortality risk among sepsis patients in the intensive care unit(ICU).Methods:This single-center,retrospective study included sepsis patients who met the inclusion criteria and were admitted to the ICU of Zigong Fourth People's Hospital between 2018 and 2023.Demographic data,clinical scores,laboratory tests,and interventions were collected.Patients were divided into high and low BUN groups based on the median BUN level at admission.Baseline differences between the groups were analyzed.In-hospital mortality was used as the endpoint.logistic regression analysis was employed to investigate the relationship between BUN levels and mortality risk.Restricted cubic spline models were applied to explore the dose-response relationship between BUN and all-cause in-hospital mortality.ROC curves were constructed to evaluate the predictive performance of BUN,sequential organ failure assessment(SOFA)score and their combination.Results:A total of 404 patients were included,of whom 63.12%were male,with a mean age of 74.5 years.The in-hospital mortality was 31.93%.The high BUN group had a significantly higher in-hospital mortality than the low BUN group(43.84%vs.19.90%).Multivariate logistic regression analysis revealed that BUN(OR=1.045,95%CI:1.014-1.077;P=0.004)and SOFA score(OR=1.267,95%CI:1.176-1.365;P<0.001)were independent risk factors for mortality.Restricted cubic spline analysis demonstrated a nonlinear relationship between BUN and mortality risk:BUN levels below 5.563 mmol/L exhibited a protective effect,whereas higher BUN levels were associated with increased mortality risk.The combined area under the ROC curve for BUN and SOFA score was 0.732(95%CI:0.676-0.732),significantly higher than that of BUN or SOFA score alone.Conclusion:Serum BUN levels are significantly associated with the risk of in-hospital mortality in ICU patients with sepsis.Incorporating BUN enhances the predictive performance of the SOFA score for in-ho

关 键 词：脓毒症 血清尿素氮 死亡风险 重症监护室 

分 类 号：R459.7[医药卫生—急诊医学]