乳酸/白蛋白比值与心跳骤停合并或并发急性肾损伤患者预后的相关性  

Correlation between lactate to albumin ratio and prognosis in patients with cardiac arrest complicated or comorbid with acute kidney injury

作　　者：翁文倩 陆建红 姬晓伟 Weng Wenqian;Lu Jianhong;Ji Xiaowei(Department of Intensive Care Unit,Huzhou Central Hospital,Affiliated Huzhou Hospital,School of Medicine,Zhejiang University,Huzhou 313000,China)

机构地区：[1]湖州市中心医院,浙江大学医学院附属湖州医院重症医学科,湖州313000

出　　处：《心脑血管病防治》2025年第2期11-15,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：浙江省自然科学基金(LGD20H150001)。

摘　　要：目的探讨乳酸/白蛋白比值(LAR)与心跳骤停(CA)合并或并发急性肾损伤(AKI)患者预后的相关性。方法回顾性分析2008至2019年美国重症监护数据库(v2.0版本)中505例CA合并或并发AKI患者的临床资料,根据28 d全因死亡的临床结局,将所有纳入患者分为存活组235例和死亡组270例,比较两组基线资料。依据LAR水平四分位数,将患者进一步分为LAR<0.66组、LAR 0.66~1.11组、LAR>1.11~2.10组和LAR>2.10组四组。采用Kaplan-Meier生存曲线比较四组28 d累积生存率的差异;采用Cox比例风险回归模型分析入重症监护室(ICU)时LAR是否是CA合并AKI患者28 d全因死亡的危险因素。采用ROC曲线评估LAR、急性生理与慢性健康Ⅱ(APACHEⅡ)评分以及联合预测患者预后的效能。结果死亡组LAR高于存活组(χ^(2)=-4.821,P<0.05)。生存曲线分析提示,LAR>2.10组患者28 d累积生存率最低,四组差异有统计学意义(χ^(2)=31.720,P<0.01)。多因素Cox回归分析显示,LAR>2.10是CA合并或并发AKI患者28 d全因死亡的危险因素(HR=1.612,P<0.05)。ROC曲线结果表明,LAR、APACHEⅡ评分及两者联合预测CA合并或并发AKI患者28 d全因死亡的AUC分别为0.624、0.603和0.637,敏感度分别为0.581、0.763和0.707,特异度分别为0.651、0.404和0.506,两者联合预测的效能优于APACHEⅡ评分单独预测(Z=2.544,P<0.01)。结论入ICU时高LAR(>2.10)是CA合并或并发AKI患者短期全因死亡的危险因素,联合APACHEⅡ评分对这类患者的短期预后具有一定的预测价值。Objective To investigate the correlation between lactate to albumin ratio(LAR)and the prognosis of patients with cardiac arrest(CA)complicated or comorbid with acute kidney injury(AKI).Methods A retrospective analysis was conducted using the clinical data of 505 patients with CA complicated or comorbid with AKI from the Medical Information Mart for Intensive Care-IV(v2.0)database from 2008 to 2019.Based on the 28-day clinical outcomes of all-cause mortality,all of the enrolled patients were divided into the survival group(235 cases)and the death group(270 cases),and the baseline data were compared.The patients were further categorized into four groups(LAR<0.66 group,LAR 0.66-1.11 group,LAR>1.11-2.10 group,and LAR>2.10 group)according to the quartiles of LAR levels.The differences in 28-day cumulative survival rates among the four groups were compared using Kaplan-Meier survival curves.Cox proportional hazards regression model was used to analyze whether LAR at the time of admission to the intensive care unit(ICU)was an independent risk factor for 28-day all-cause mortality in patients with CA complicated or comorbid with AKI.The ROC curve was used to assess the performance of LAR,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,and the combined indicator in predicting prognosis of patients.Results The LAR level was higher in the death group than in the survival group(χ^(2)=-4.821,P<0.05).Survival curve analysis indicated that patients in the LAR>2.10 group had the lowest 28-day cumulative survival rate,the difference among the four groups was statistically significant(χ^(2)=31.720,P<0.01).Multivariate Cox regression analysis showed that LAR>2.10 was an independent risk factor for 28-day all-cause mortality in patients with CA complicated or comorbid with AKI(HR=1.612,P<0.05).The ROC curves demonstrated that the AUCs for predicting 28-day all-cause mortality in patients with CA complicated or comorbid with AKI were 0.624 for LAR,0.603 for the APACHEⅡscore,and 0.637 for the combined indicators,

关 键 词：乳酸与白蛋白比值 心跳骤停 急性肾损伤 预后 

分 类 号：R47[医药卫生—护理学]