坏死性胰腺炎患者血清肌酐与白蛋白比与死亡率关系  

Relationship between serum creatinine to albumin ratio and mortality in patients with necrotizing pancreatitis

作　　者：张俊新 康文松 李海山[1] ZHANG Jun-xin;KANG Wen-song;LI Hai-shan(Department of Emergency Medicine,The Second People's Hospital of Hefei,Hefei Hospital Afilia-ted to Anhui Medical University,Hefei230011)

机构地区：[1]合肥市第二人民医院(安徽医科大学附属合肥医院)急诊科,合肥230011

出　　处：《肝胆外科杂志》2025年第1期34-40,共7页Journal of Hepatobiliary Surgery

摘　　要：目的本研究旨在评估血清肌酐/白蛋白(creatinine to albumin ratio,CAR)与坏死性胰腺炎患者死亡率之间的关系。方法本研究使用重症监护医疗信息市场(MIMIC-IV,3.1)数据库的数据进行了回顾性研究。研究包括分析各种死亡率变量并获得人院时的CAR值。使用ROC截断值确定CAR的最佳阈值。采用受试者工作特征分析(Receiver Operating Characteristic analysis)研究CAR对坏死性胰腺炎患者死亡率的预测能力、敏感性、特异性和曲线下面积(Area under curve,AUC),根据ROC截断值将将CAR≥0.44的坏死性胰腺炎患者分为高CAR组,CAR<0.44的坏死性胰腺炎患者分为低CAR组。使用Kaplan-Meier生存曲线评估高和低CAR组患者与死亡率之间的关系。结果共纳人156名符合标准的坏死性胰腺炎患者,采用ROC曲线评估CAR对坏死性胰腺炎患者死亡率的预测能力,截断值为0.44。根据截断值分为高CAR组和低CAR组,两组之间年龄、有无糖尿病、平均动脉压、血氯、血钾、血钙、血糖、尿素氮、肌酐、总胆红素、谷丙转氨酶、谷草转氨酶、白蛋白、白细胞计数、血小板计数、氧分压和CAR之间P<0.05,有统计学差异。两组之间住院天数、30天存活时间、60天存活时间和90天存活时间之间P<0.05,有统计学差异。R0C结果显示曲线下面积0.782,95%CI(0.678,0.886);敏感性,0.655,95%CI(0.482,0.828);特异性,0.874,95%CI(0.816,0.932);阳性预测值,0.543,95%CI(0.378,0.708);阴性预测值,0.917,95%CI(0.868,0.966)。CAR与急性生理与慢性健康评分(Acute Physiology and Chronic Health Evaluation Ⅱ,A-PACHEI)评分进行ROC比较,CARAUC值方面,0.782,95%CI(0.678,0.886),APACHEIIAUC值方面,0.642,95%CI(0.526,0.703)。对低CAR和高CAR两组坏死性胰腺炎患者30天、60天和90天的使用Kaplan-Meier法绘制生存曲线,log rank检验P<0.05,高CAR组坏死性胰腺炎的患者病死率明显高于低CAR组坏死性胰腺炎的患者。结论CAR可作为坏死性胰腺炎患�I Objective The aim of this study was to assess the relationship between serum creatinine/albumin(creatinine to albumin ratio,CAR)and mortality in patients with necrotizing pancreatitis.Methods This study was conducted retrospectively using data from the Medical Information Marketplace in Intensive Care(MIMIC-IV,3.1)database.The study consisted of analyzing various mortality variables and obtaining CAR values at admission.Optimal thresholds for CAR were determined using ROC cutoff values.Re-ceiver Operating Characteristic analysis(ROC)was used to study the predictive ability,sensitivity,specificity and Area under curve(AUC)of CAR for mortality in patients with necrotizing pancreatitis.Based on the ROC cut-off value,patients with CAR≥O.44 were categorized into patients with necrotizing pancreatitis.Necrotizing pancreatitis patients with CAR≥O.44 were categorized into high CAR group and necrotizing pancreatitis patients with CAR<O.44 were categorized into low CAR group based on the ROC cut-off value.The relationship between patients in the high and low CAR groups and mortality was assessed using Kaplan-Meier survival curves.Re-sultsA total of 156 patients with necrotizing pancreatitis who met the criteria were enroled,and the predictive ability of CAR for mor-tality in patients with necrotizing pancreatitis was assessed by using a ROC curve,with a cut-off value of O.44.Based on the cut-off value,they were divided into a high CAR group and a low CAR group,and between the two groups there was a statistically significant difference in age,presence or absence of diabetes mellitus,mean arterial pressure,blood chloride,potassium,calcium,blood glu-cose,urea nitrogen,creatinine,total bilirubin,glutamine transaminase,Glutamine aminotransferase,albumin,white blood cell count,platelet count,oxygen partial pressure and CAR were statistically different between P<0.05.There was a statistical difference with P<0.05 between the number of days of hospitalization,30-day survival time,60-day survival time and 90-day survival time

关 键 词：肌酐白蛋白比 坏死性胰腺炎 死亡率 MIMIC-IV 

分 类 号：R659[医药卫生—外科学]