摘要
目的探讨入ICU时阴离子间隙(AG)评估老年心脏停搏(CA)患者预后的价值。方法回顾美国重症监护医学信息数据库(MIMIC-Ⅲ)588例老年CA患者。按照AG数值三分位数进行分组(<14.00 mmol/L 198例,14.00~17.00 mmol/L 181例和>17.00 mmol/L 209例),比较3组患者的临床资料。生存分析采用Kaplan-Meier法,并用log-rank检验比较各组患者28 d和90 d累积生存率的差异。运用Cox回归风险模型分析AG对CA患者全因死亡率的影响。结果588例患者平均序贯器官衰竭评分(SOFA)评分(6.24±3.55)分,ICU住院期间、28 d及90 d全因死亡率分别为35.71%、48.13%和56.46%。3组间SOFA评分、AG、pH、平均红细胞体积、WBC、Hb、ALT、肌酐、血钾、血总钙、合并高血压、合并糖尿病、合并心肌梗死、28 d和90 d全因死亡率差异均有统计学意义(均P<0.05)。Kaplan-Meier生存分析表明,各组CA患者28 d和90 d累积生存率之间差异均有统计学意义(χ^(2)=10.78、13.55,均P<0.01)。多因素Cox回归风险模型表明,AG水平上升(>17.00 mmol/L)是增加CA患者90 d全因死亡率的独立危险因素(HR=1.381,95%CI:1.020~1.869,P<0.05)。结论入ICU时增高的AG(>17.00 mmol/L)是预测老年CA患者90 d全因死亡率的独立危险因素,可作为此类患者预后的评估指标。
Objective To evaluate the relationship between anion gap(AG)at admission to intensive care unit(ICU)and the prognosis of elderly patients with cardiac arrest(CA).Methods The data of patients with CA were obtained from a public database Medical Information Mart for Intensive Care Ⅲ(MIMIC-Ⅲ).Patients were divided into 3 groups according to the tertiles of AG levels(AG<14.00 mmol/L:n=198,AG 14.00-17.00 mmol/L:n=181 and AG>17.00 mmol/L:n=209).The general information and clinically relevant indexes of the 3 groups were compared.The survival analysis was conducted by Kaplan-Meier method,and 28-day and 90-day cumulative survival rates were analyzed by the log-rank test.The effect of AG on all-cause mortality in CA patients was appraised by the Cox regression risk models.Results The study included 588 elderly CA patients with a mean SOFA score of 6.24±3.55.The all-cause mortality rates during ICU stay,within 28 days and 90 days were 35.71%,48.13%and 56.46%,respectively.There were significant differences in SOFA score,AG,pH,mean corpuscular volume,white blood cell,hemoglobin,alanine aminotransferase,creatinine,serum potassium,total serum calcium,hypertension,diabetes,myocardial infarction,28-day and 90-day all-cause mortality among three groups.According to Kaplan-Meier analysis,there were significant differences in 28-day and 90-day cumulative survival rates among 3 groups(χ^(2)=10.78,13.55,P<0.01).Multivariate Cox model showed that increased AG level(>17.00 mmol/L)was an independent risk factor for increased 90-day all-cause mortality(HR=1.381,95%CI:1.020-1.869,P<0.05)in these patients.Conclusion A raised AG level(>17.00 mmol/L)at ICU admission is an independent risk factors for 90-day all-cause mortality in elderly CA patients and it may serve as a candidate marker for predicting the clinical outcome of elderly patients suffering CA.
作者
富明民
姬晓伟
钟磊
王海丽
谢波
FU mingmin;JI Xiaowei;ZHONG Lei;WANG Haili;XIE Bo(不详;Department of Intensive Care Unit,Huzhou Central Hospital,The Affiliated Huzhou Hospital of Zhejiang University School of Medicine,Huzhou 313000,China)
出处
《浙江医学》
CAS
2022年第1期42-45,59,共5页
Zhejiang Medical Journal
基金
浙江省基础公益研究计划项目(LGD20H150001)。
