早期乳酸/白蛋白比值联合快速序贯器官衰竭评分对社区获得性肺炎脓毒症患者预后的急诊预测价值  

Early lactate/albumin ratio combined with quick sequential organ failure assessment for predicting the prognosis of sepsis caused by community-acquired pneumonia in the emergency department

作　　者：张新颜[1] 安莹波[1] 董叶子 李敏 李然 李金兴 Zhang Xinyan;An Yingbo;Dong Yezi;Li Min;Li Ran;Li Jinxing(Department of Emergency,Beijing Haidian Hospital(Haidian Section of Peking University Third Hospital),Beijing 100080,China)

机构地区：[1]北京市海淀医院(北京大学第三医院海淀院区)急诊医学科,北京100080

出　　处：《中华危重病急救医学》2025年第2期118-122,共5页Chinese Critical Care Medicine

基　　金：国家公立医院改革与高质量发展示范项目(2024-295)。

摘　　要：目的探讨早期乳酸/白蛋白比值(LAR)联合快速序贯器官衰竭评分(qSOFA)对急诊社区获得性肺炎(CAP)致脓毒症患者28 d预后的预测价值。方法回顾性分析2021年6月至2022年8月北京市海淀医院急诊科收治CAP致脓毒症患者的临床资料,包括性别、年龄、合并症、入院1 h内乳酸(Lac)、血清白蛋白(Alb)、LAR、降钙素原(PCT)及28 d预后等。根据28 d预后将患者分为两组,采用单因素及多因素Cox回归方法分析影响患者预后的危险因素。根据LAR最佳截断值将患者分为两组,采用Kaplan-Meier生存曲线分析各组患者28 d累积生存情况。绘制时间依赖受试者工作特征曲线(ROC曲线),分析序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及qSOFA+LAR评分对CAP致脓毒症患者28 d预后的预测价值,计算曲线下面积(AUC)并进行比较。结果共纳入116例CAP致脓毒症患者,其中28 d存活80例,死亡36例,28 d病死率为31.0%。存活组与死亡组患者年龄、性别、合并症、pH值、血小板计数、纤维蛋白原等指标比较差异均无统计学意义,而血尿素氮(BUN)、白细胞计数(WBC)、血红蛋白、Lac、Alb、PCT、D-二聚体、LAR、qSOFA评分、SOFA评分和APACHEⅡ评分比较差异均有统计学意义。单因素Cox回归分析显示,BUN、WBC、pH值、Lac、Alb、PCT、LAR、qSOFA评分、SOFA评分和APACHEⅡ评分均与死亡结局相关;将上述变量进行多因素Cox回归分析显示,BUN、WBC、PCT和APACHEⅡ评分是急诊科CAP致脓毒症患者28 d死亡的独立危险因素〔风险比(HR)分别为1.081、0.892、1.034、1.135,均P<0.05〕。早期LAR预测脓毒症患者28 d预后的最佳截断值为0.088,Kaplan-Meier生存曲线显示,LAR≤0.088组脓毒症患者28 d累积生存率明显高于LAR>0.088组〔82.9%(63/76)比42.5%(17/40),Log-Rank检验:χ^(2)=22.51,P<0.001〕。根据LAR截断值和qSOFA评分计算qSOFA+LAR评分,ROC曲线分析显示,SOFA评分、APACHEⅡ评分�Objective To investigate the predictive value of early lactate/albumin ratio(LAR)combined with quick sequential organ failure assessment(qSOFA)for the 28-day prognosis of patients with sepsis caused by emergency community-acquired pneumonia(CAP).Methods The clinical data of patients with sepsis caused by CAP admitted to the department of emergency of Beijing Haidian Hospital from June 2021 to August 2022 were retrospectively analyzed,including gender,age,comorbidities,lactic acid(Lac),serum albumin(Alb),LAR,procalcitonin(PCT)within 1 hour,and 28-day prognosis.Patients were divided into two groups based on 28-day prognosis,and risk factors affecting patients'prognosis were analyzed using univariate and multivariate Cox regression methods.Patients were divided into two groups according to the best cut-off value of LAR,and Kaplan-Meier survival curves were used to analyze the 28-day cumulative survival of patients in each group.Time-dependent receiver operator characteristic curve(ROC curve)were plotted to analyze the predictive value of sequential organ failure assessment(SOFA),acute physiology and chronic health evaluation Ⅱ(APACHEⅡ),and qSOFA+LAR score on the prognosis of patients with sepsis caused by CAP at 28 days.The area under the curve(AUC)was calculated and compared.Results A total of 116 patients with sepsis caused by CAP were included,of whom 80 survived at 28 days and 36 died,28-day mortality of 31.0%.There were no statistically significant differences in age,gender,comorbidities,pH,platelet count,and fibrinogen between the survival and death groups,and there were significantly differences in blood urea nitrogen(BUN),white blood cell count(WBC),hemoglobin,Lac,Alb,PCT,D-dimer,LAR,as well as qSOFA score,SOFA score,and APACHEⅡ score.Univariate Cox regression analyses showed that BUN,WBC,pH,Lac,Alb,PCT,LAR,qSOFA score,SOFA score,and APACHEⅡ score were associated with mortality outcome.Multifactorial Cox regression analysis of the above variables showed that BUN,WBC,PCT,and APACHEⅡscore were indepe

关 键 词：乳酸/白蛋白比值 快速序贯器官衰竭评分 社区获得性肺炎 脓毒症 急诊科 

分 类 号：R563.1[医药卫生—呼吸系统]