慢性阻塞性肺疾病急性加重合并肺炎患者血尿素氮水平与住院全因死亡风险的相关性  

Correlation between blood urea nitrogen levels and the risk of all-cause in-hospital death in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with pneumonia

作　　者：杜洁[1] 杨斯迪[2] 牛晶 李红艳[1] 隋永杰[1] Du Jie;Yang Sidi;Niu Jing;Li Hongyan;Sui Yongjie(Department of Health Management Center,Shaanxi Provincial People′s Hospital,Xi′an 710068,China;Hanzhong People′s Hospital Health Management Center,Hanzhong 723000,China)

机构地区：[1]陕西省人民医院健康管理中心,西安710068 [2]汉中市人民医院健康管理中心,汉中723000

出　　处：《中华健康管理学杂志》2025年第3期184-191,共8页Chinese Journal of Health Management

基　　金：陕西省重点研发计划项目(2024SF-YBXM-108)。

摘　　要：目的探讨慢性阻塞性肺疾病急性加重(AECOPD)合并肺炎住院患者血尿素氮(BUN)水平与住院全因死亡风险的相关性。方法本研究是一项多中心、回顾性队列研究的二次分析,数据来源于DATADRYAD数据库日本5家医院(Kameda医院、Hyogo医院、Awa医院、Saiseikai医院、Ichinomiyanishi医院)的研究。数据库共纳入2008年4月至2019年8月,年龄≥40岁的AECOPD合并肺炎住院患者1237例,在排除了11例入院时缺失BUN水平数据者后,共1226例患者被纳入本研究进行二次分析。以入院时BUN水平为目标自变量,住院期间全因住院死亡为因变量。采用风险比例回归分析评估BUN水平与AECOPD合并肺炎患者住院死亡风险之间的独立相关性;并应用广义相加模型及平滑曲线拟合方法探讨非线性关系,进一步进行亚组分析,评估不同亚组相关性的一致,进一步验证结果的可靠性。结果调整性别、年龄等潜在混杂因素后,BUN水平与住院全因死亡风险呈正相关[OR=1.09(95%CI:1.01~1.17),P=0.032]。BUN水平与住院全因死亡风险呈非线性关系,其拐点为43.3 mg/dl。拐点左右两侧的效应量和95%CI分别为1.04(0.93~1.16)和1.08(1.05~1.12)。当BUN>43.3 mg/dl时,BUN与住院全因死亡风险呈正相关,BUN每增加1.0 mg/dl,死亡风险增加8.0%(P<0.05);当BUN<43.3 mg/dl时,BUN与住院全因死亡风险无显著相关(P=0.534)。亚组分析表明,在性别、年龄、来源医院、发热、呼吸、心率、肺部啰音、精神状态改变、类固醇治疗、气管插管、完全协助日常活动、医疗保险和住院时长各亚组,BUN水平与AECOPD合并肺炎患者住院全因死亡风险的OR值均具有良好的稳定性(均OR>1.00)。结论BUN水平与AECOPD合并肺炎患者住院全因死亡风险增加有相关性,当43.3 mg/dl时,BUN水平与AECOPD合并肺炎患者住院全因死亡风险呈正相关。ObjectiveTo explore the relationship between blood urea nitrogen(BUN)levels and the risk of all-in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pneumonia.MethodsThis study was a secondary analysis of a multicenter,retrospective cohort study,with data sourced from the DATADRYAD database of five hospitals in Japan(Kameda Hospital,Hyogo Hospital,Awa Hospital,Saiseikai Hospital,and Ichinomiyanishi Hospital).The database included 1237 cases of AECOPD with pneumonia hospitalized from April 2008 to August 2019,aged≥40 years.After excluding 11 cases with missing BUN level data at admission,a total of 1226 patients were included in this secondary analysis.BUN level at admission was used as the target independent variable,and all-cause in-hospital mortality during hospitalization was the dependent variable.Risk ratio regression analysis was used to assess the independent correlation between BUN level and the risk of in-hospital mortality due to AECOPD complicated with pneumonia;generalized additive models and smoothing curve fitting methods were applied to explore nonlinear relationships,followed by subgroup analyses to evaluate the consistency of the association across different subgroups and further validate the reliability of the findings.ResultsAfter adjusting for potential confounding factors such as gender and age,BUN levels were positively correlated with the risk of all-cause in-hospital mortality[OR=1.09(95%CI:1.01-1.17),P=0.032].There was a relationship between BUN levels and the risk of all-cause in-hospital mortality,with a turning point at 43.3 mg/dl.The sizes and 95%CI on either side of the turning point were 1.04(0.93-1.16)and 1.08(1.05-1.12),respectively.When BUN>43.3 mg/dl,BUN was correlated with the risk of all-cause in-hospital mortality,with an 8.0%increase in the risk of death for every 1.0 mg/dl increase in BUN(P<0.05);when BUN<43.3 mg/dl,there was no significant relationship between BUN and the risk of all-cause in-hospital

关 键 词：肺疾病 慢性阻塞性 尿素氮 全因死亡风险 急性加重期 相关性 

分 类 号：R56[医药卫生—呼吸系统]