摘要
目的探讨白蛋白(ALB)、天冬氨酸转氨酶/丙氨酸转氨酶比值(AST/ALT比值)对脓毒症超急性期急性肝衰竭(ALF)患者预后的预测价值,为临床评估病情和判断预后及采取相应治疗措施提供依据。方法采用多中心回顾性队列研究方法,选择2019年1月至2024年2月在上海健康医学院附属周浦医院、上海市浦东新区人民医院、上海市东方医院住院的脓毒症超急性期ALF患者。收集患者性别、年龄等一般资料,入院24 h内乳酸脱氢酶(LDH)、肝功能指标〔总胆红素(TBIL)、直接胆红素(DBIL)、AST、ALT、AST/ALT比值、ALB、总蛋白(TP)、球蛋白(GLB)、ALB/GLB比值(A/G)、血胺、γ-谷氨酰转肽酶(γ-GT)〕、血小板计数(PLT)、肌酐、活化部分凝血活酶时间(APTT)、病情危重程度评分〔急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)〕、血清降钙素原(PCT)、N末端脑利尿钠肽前体(NT-proBNP)、动脉血乳酸(Lac),住院期间是否应用机械通气、是否使用血管活性药物、是否行人工肝治疗,以及住院期间的预后。比较不同预后患者间各指标的差异,将单因素分析中差异有统计学意义的变量纳入多因素Logistic回归分析,确定脓毒症超急性期ALF患者住院期间死亡的独立危险因素;绘制受试者工作特征曲线(ROC曲线),评估ALB、AST/ALT比值对脓毒症超急性期ALF患者住院期间死亡的预测价值。结果最终有73例脓毒症超急性期ALF患者纳入分析,住院期间存活22例,死亡51例,病死率为69.86%。与存活组相比,死亡组患者入院24 h内ALB、γ-GT、人工肝治疗比例更低,AST/ALT比值、SOFA评分、LDH、使用血管活性药物比例更高,差异具有统计学意义。多因素Logistic回归分析显示,ALB、AST/ALT比值是脓毒症超急性期ALF患者住院期间死亡的独立危险因素〔ALB:优势比(OR)=0.856,95%可信区间(95%CI)为0.736~0.996,P=0.044;AST/ALT比值:OR=2.018,95%CI为1.137~3.580,P=0.016〕。ROC曲线分析显示,ALB预测脓毒症超急性期ALF患者住院期间死亡的曲线下面积(AUC)为0.760(95%CI为0.637~0.884,P<0.001);当ALB≤29.05 g/L时,敏感度为68.2%,特异度为76.5%。AST/ALT比值预测脓毒症超急性期ALF患者住院期间死亡的AUC为0.764(95%CI为0.639~0.888,P<0.001);当AST/ALT比值≥1.26时,敏感度为59.1%,特异度为90.2%。结论入院24 h内ALB越低,AST/ALT比值越高,脓毒症超急性期ALF患者预后越差;ALB、AST/ALT比值可作为脓毒症超急性期ALF患者病情危重程度和预后评估的临床指标。
Objective To investigate the prognostic value of albumin(ALB),aspartate aminotransferase/alanine aminotransferase ratio(AST/ALT)in patients with acute liver failure(ALF)in hyperacute phase of sepsis which provided the basis for clinical evaluation and prognostic judgment and corresponding treatment options.Methods A multicenter retrospective cohort study was conducted.Patients with ALF in hyperacute phase of sepsis admitted to Zhoupu Hospital Affiliated to Shanghai Health College,Shanghai Pudong New Area People's Hospital,and Shanghai Oriental Hospital from January 2019 to February 2024 were enrolled.General data such as gender and age of the patients were collected.Lactate dehydrogenase(LDH),liver function indexes[total bilirubin(TBIL),direct bilirubin(DBIL),AST,ALT,AST/ALT,ALB,total protein(TP),globulin(GLB),ALB/GLB ratio(A/G),blood amine,γ-glutamyl transpeptidase(γ-GT)],platelet count(PLT),creatinine,activated partial thromboplastin time(APTT),severity of illness scores[acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)],serum procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),arterial blood lactic acid(Lac)within 24 hours after admission,and whether to use mechanical ventilation,whether to use vasoactive drugs,whether to use artificial liver treatment and prognosis during hospitalization also were collected.The differences of clinical data between patients with different prognosis were compared.The variables with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis to determine the independent risk factors for death of patients with ALF in hyperacute phase of sepsis during hospitalization.The receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of ALB and AST/ALT for death of patients with ALF in hyperacute phase of sepsis during hospitalization.Results A total of 73 patients with ALF in hyperacute phase of sepsis were included,with 22 survived and 51 died during hospitalization and the mortality of 69.86%.Compared with the survival group,the patients in the death group had lower ALB,γ-GT within 24 hours after admission and proportion of artificial liver treatment,and higher AST/ALT,SOFA score,LDH and proportion of use of vasoactive drugs.The differences were statistically significant.Multivariate Logistic regression analysis showed that ALB and AST/ALT were the independent risk factors for death in patients with ALF in hyperacute phase of sepsis during hospitalization[ALB:odds ratio(OR)=0.856,95%confidence interval(95%CI)was 0.736-0.996,P=0.044;AST/ALT:OR=2.018,95%CI was 1.137-3.580,P=0.016].ROC curve analysis showed that the area under the curve(AUC)of ALB for predicting in-hospital death in patients with ALF in hyperacute phase of sepsis was 0.760(95%CI was 0.637-0.884,P<0.001).When ALB≤29.05 g/L,the sensitivity was 68.2%,and the specificity was 76.5%.The AUC of AST/ALT for predicting in-hospital death in patients with ALF in hyperacute phase of sepsis was 0.764(95%CI was 0.639-0.888,P<0.001).When AST/ALT≥1.26,the sensitivity was 59.1%,and the specificity was 90.2%.Conclusion sThe lower the ALB level,and the higher the AST/ALT within 24 hours after admission,the worse the prognosis of patients with ALF in hyperacute phase of sepsis.ALB and AST/ALT can be used as clinical indicators to evaluate the severity and prognosis of patients with ALF in hyperacute phase of sepsis.
作者
李小舟
尹倩倩
赵广阔
海亚楠
孙志萍
常云丽
Li Xiaozhou;Yin Qianqian;Zhao Guangkuo;Hai Yanan;Sun Zhiping;Chang Yunli(Department of Emergency Medicine,Zhoupu Hospital Affiliated to Shanghai Health College(Shanghai Pudong New Area Zhoupu Hospital),Shanghai 201318,China;Department of Oncology,Shanghai Oriental Hospital,Shanghai 200120,China;Medical Records Room,Zhoupu Hospital Affiliated to Shanghai Health College(Shanghai Pudong New Area Zhoupu Hospital),Shanghai 201318,China;Department of Gastroenterology,Shanghai Pudong New Area People's Hospital,Shanghai 201299,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2024年第11期1121-1126,共6页
Chinese Critical Care Medicine
基金
浦东新区卫生系统特色专病建设计划项目(PWZzb2022-30)。
关键词
白蛋白
天冬氨酸转氨酶/丙氨酸转氨酶比值
脓毒症
超急性期急性肝衰竭
预后
肝功能
Albumin
Aspartate aminotransferase/alanine aminotransferase ratio
Sepsis
Acute liver failure in hyperacute phase
Prognosis
Liver function
