乳酸脱氢酶与白蛋白比值在心脏骤停合并急性肾损伤预后评估中的价值  

Value of lactate dehydrogenase to albumin ratio in prognostic assessment of cardiac arrest combined with acute kidney injury

作　　者：章凯[1] 徐鑫[1] 钟磊 闵婕 ZHANG Kai;XU Xin;ZHONG Lei;MIN Jie(Department of Emergency Medicine,Huzhou Central Hospital(The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University),Huzhou 313000,China;不详)

机构地区：[1]湖州市中心医院(浙江中医药大学第五临床医学院)急诊医学科,313000 [2]湖州市中心医院(浙江中医药大学第五临床医学院)重症医学科,313000

出　　处：《心电与循环》2025年第2期149-153,158,共6页Journal of Electrocardiology and Circulation

基　　金：浙江省医药卫生科技计划项目(2023KY314);湖州市科技计划项目(2022GY20)。

摘　　要：目的探讨入住重症监护病房(ICU)时血清乳酸脱氢酶(LDH)与白蛋白比值(LAR)在心脏骤停合并急性肾损伤(AKI)预后评估中的价值。方法回顾性收集美国重症监护医学信息数据库2.0中2008至2019年首次入住ICU的心脏骤停合并AKI患者417例,根据入院后90 d存活情况分为存活组141例和死亡组276例,比较两组患者临床资料;根据入住ICU时LAR三分位数分为<10.96组139例、10.96~24.26组139例、>24.26组139例,比较3组患者90及360 d累积死亡率;采用Cox比例风险回归模型分析LAR与心脏骤停合并AKI患者90及360 d全因死亡的关系。结果存活组与死亡组患者在急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、简明急性生理学评价Ⅱ(SAPSⅡ)评分、LDH、LAR、白蛋白、血红蛋白、红细胞压积、红细胞分布宽度、天冬氨酸氨基转移酶、乳酸、尿素氮、血肌酐、凝血酶原时间、阴离子间隙、血磷、ICU住院时间以及连续性肾脏替代治疗、使用肾上腺素、使用去甲肾上腺素、使用呋塞米、合并心力衰竭比例等方面比较,差异均有统计学意义(均P<0.05)。不同LAR水平患者90、360 d累积死亡率分别为48.92%、67.63%、82.01%和54.68%、71.22%、83.45%,差异均有统计学意义(均P<0.01)。控制APACHEⅡ评分、SAPSⅡ评分、乳酸、血红蛋白、红细胞压积、红细胞分布宽度、天冬氨酸氨基转移酶、阴离子间隙、尿素氮、肌酐、凝血酶原时间、血磷、合并心力衰竭、经胸超声心动图、连续性肾脏替代治疗、使用肾上腺素、使用去甲肾上腺素、使用呋塞米等混杂因素后发现,LAR>24.26(HR=2.059、1.989,均P<0.01)是心脏骤停合并AKI患者90及360 d全因死亡的独立危险因素。结论入住ICU时LAR>24.26提示心脏骤停合并AKI患者近期和远期死亡风险增加,可辅助临床医生早期识别高危患者。Objective To explore the value of the serum lactate dehydrogenase(LDH)to albumin ratio(LAR)at intensive care unit(ICU)admission in prognostic assessment of cardiac arrest complicated with acute kidney injury(AKI).Methods A total of 417 patients with cardiac arrest complicated with AKI who were first admitted to the ICU from 2008 to 2019 were retrospectively collected from the US Medical Information Mart for Intensive Care 2.0.Based on 90-day survival outcomes,patients were divided into a survival group(141 cases)and a death group(276 cases),and clinical data were compared between the two groups.According to the tertiles of LAR at ICU admission,patients were categorized into three groups:<10.96 group(139 cases),10.96-24.26 group(139 cases),and>24.26 group(139 cases).The 90-day and 360-day cumulative mortality rates were compared among the three groups.The Cox proportional hazards regression model was used to analyze the relationship between LAR and 90-day and 360-day all-cause mortality in patients with cardiac arrest complicated with AKI.Results Statistically significant differences were observed between the survival and death groups in Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Simplified Acute Physiology ScoreⅡ(SAPSⅡ)score,LDH,LAR,albumin,hemoglobin,hematocrit,red blood cell distribution width,aspartate aminotransferase,lactate,blood urea nitrogen,serum creatinine,prothrombin time,anion gap,serum phosphorus,ICU length of stay,and proportions of continuous renal replacement therapy,use of epinephrine,use of norepinephrine,use of furosemide,and comorbid heart failure(all P<0.05).The 90-day and 360-day cumulative mortality rates among patients with different LAR levels were 48.92%,67.63%,82.01%and 54.68%,71.22%,83.45%,respectively,with significant differences(all P<0.01).After adjusting for confounding factors such as APACHEⅡscore,SAPSⅡscore,lactate,hemoglobin,hematocrit,red blood cell distribution width,aspartate aminotransferase,anion gap,blood urea nitrogen,creatinine,prothrombin

关 键 词：乳酸脱氢酶与白蛋白比值 心脏骤停 急性肾损伤 预后 

分 类 号：R541[医药卫生—心血管疾病]