摘要
目的探讨乳酸(Lac)与白蛋白比值(LAR)与心脏骤停患者28天预后之间的关系。方法纳入美国重症监护医学信息数据库(MIMIC)-Ⅳ中的心脏骤停患者548例,按照28天预后情况将其分为生存组(286例)及死亡组(262例)。比较两组患者一般临床资料及入ICU 24h内的实验室检查结果。采用单因素和多因素回归分析评估心脏骤停患者28天死亡的危险因素。采用分层多因素cox回归分析评估各因素与LAR对ICU心脏骤停患者28天死亡率的影响。采用Kaplan-Meier曲线和log-rank(Mantel-cox)试验评估LAR与患者28天预后之间的关系。结果生存组患者Alb、PaO2、BE均高于死亡组,年龄、ALT、AST、肌酐(Cr)、尿素氮(BUN)、二氧化碳分压(PaCO_(2))、LAR、Lac及痴呆、转移性实体瘤患者比例均低于死亡组(P<0.05)。单因素分析结果显示,年龄、种族、WBC计数、Alb、Lac、PaCO_(2)、碱剩余(BE)、凝血酶原时间(PT)、LAR均为心脏骤停28天患者死亡风险的影响因素(P<0.05)。多因素回归分析在调整年龄、性别、序贯器官衰竭(SOFA)评分、共病指数等混杂因素后,LAR与28天死亡风险的正相关关系仍然显著(P<0.05)。分层多因素Cox回归分析结果显示,年龄、性别、种族、血管活性药物治疗、肾脏替代治疗、机械通气均未对LAR与ICU心脏骤停患者28天死亡率产生交互作用,结果较稳定(P<0.05)。Kaplan-Meier曲线分析结果显示,LAR水平较高患者的生存率较低(P<0.001)。结论LAR作为一种新的预后评估指标,其水平与心脏骤停患者28天预后情况密切相关。
Objective To explore the relationship between the ratio of lactic acid to albumin(LAR)and the 28-day prognosis of cardiac arrest patients.Methods A total of 548 cardiac arrest patients from the American Medical Information Mart for Intensive Care(MIMIC)⁃Ⅳwere enrolled.All patients were divided into survival group(286 cases)and death group(262 cases)according to 28⁃day prognosis.The general clinical data and laboratory examination results within 24 hours of ICU admission were collected and compared between groups.Univariate and multivariate regression analyses were used to evaluate the risk factors for 28⁃day mortality in cardiac arrest patients.Stratified multivariate cox regression analysis was used to evaluate the effects of each factor and LAR on the 28⁃day mortality of cardiac arrest patients in the ICU.Correlation between LAR level and 28⁃day survival rate was evaluated by using the Kaplan⁃meier curve and log⁃rank(Mantel⁃cox)test.Results In survival group,Alb,PaO2,and BE were all higher than those in death group,while age,ALT,AST,creatinine(Cr),blood urea nitrogen(BUN),partial pressure of carbon dioxide(PaCO_(2)),LAR,Lac,and the proportions of patients with dementia and metastatic solid tumors were all lower than those in death group(P<0.05).Univariate analysis results showed that age,race,WBC count,Alb,Lac,PaCO_(2),base residue(BE),prothrombin time(PT)and LAR were all influencing factors of the risk of death in patients with 28⁃day cardiac arrest(P<0.05).After adjusting for confounding factors such as age,gender,sequential organ failure assessment(SOFA)score,comorbidity index,multivariate regression analysis,the positive correlation between LAR and 28⁃day mortality risk remained significant(P<0.05).Stratified multivariate cox regression analysis results showed that age,gender,race,vasoactive drug therapy,renal replacement therapy and mechanical ventilation didn’t interact with LAR and 28⁃day mortality in cardiac arrest patients of ICU,and the results were relatively stable(P<0.05).Kaplan⁃Meier curve analysis results showed that patients with higher LAR levels had lower survival rates(P<0.001).Conclusion As a new prognostic assessment indicator,the level of LAR is closely related to the 28⁃day prognosis of patients with cardiac arrest.
作者
周高生
廖祥鑫
余晓刚
章宜兰
张蓉
Zhou Gaosheng;Liao Xiangxin;Yu Xiaogang;Zhang Yilan;Zhang Rong(Department of emergency and critical care medicine,the first clinical medical college of china three gorges university(yichang central people’s hospital),yichang 443003,China;不详)
出处
《临床内科杂志》
2025年第10期823-827,共5页
Journal of Clinical Internal Medicine
基金
北京市自然科学基金面上项目(7232126)
北京重症超声研究会专题科研项目(2023-CCUSG-A-03)
宜昌市医疗卫生项目(A24-2-011)。
关键词
心脏骤停
乳酸
白蛋白
预后评估
美国重症监护医学信息数据库Ⅳ
Cardiac arrest
Lactate
Albumin
Assessment of prognosis
American Medical Information Mart for Intensive Care⁃Ⅳ
