摘要
目的探讨红细胞分布宽度/白蛋白比值(RAR)与脓毒症相关急性肾损伤(SA-AKI)患者短期死亡风险的关系。方法回顾性收集美国重症监护医学信息数据库中3576例SA-AKI患者的临床资料。根据患者28 d生存结局,将其分为生存组2422例和死亡组1154例。构建多因素Cox回归模型,评价RAR与SA-AKI患者生存结局的关联。基于Cox模型调用限制性立方样条函数进行曲线拟合,探索RAR与SA-AKI患者28 d死亡率的相关性。采用Kaplan-Meier生存分析,探究不同RAR水平SA-AKI患者28 d死亡率的差异。最后使用亚组分析评价结果的稳健性。结果多因素Cox回归分析结果表明RAR是影响SA-AKI患者28 d死亡率的独立危险因素(HR=1.058,P<0.001)。平滑曲线拟合显示SA-AKI患者28 d死亡率与RAR呈正相关。同时Kaplan-Meier生存曲线分析结果显示高RAR水平组28 d死亡率明显高于低RAR水平组(P<0.001)。亚组分析结果表明,在性别、年龄、种族、是否口服血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂类药物、是否存在急性呼吸衰竭、心房颤动、糖尿病亚组中,RAR均是SA-AKI患者28 d死亡的危险因素。结论RAR水平升高与SA-AKI患者短期死亡风险增加相关,RAR水平对SAAKI患者短期预后有一定预测价值。
Objective To investigate the association between the red cell distribution width-to-albumin ratio(RAR)and short-term mortality in patients with sepsis-associated acute kidney injury(SA-AKI).Methods This retrospective cohort study analyzed clinical data of 3576 SA-AKI patients from the Medical Information Mart for Intensive Care database.The primary outcome was 28 d mortality.Patients were stratified into survival(n=2422)and non-survival groups(n=1154).Multivariate Cox proportional hazards regression models were constructed to evaluate the independent association between RAR and survival outcomes.Restricted cubic splines were used to model the dose-response relationship between RAR and mortality risk.Kaplan-Meier survival analysis was performed to compare mortality between patients with different RAR levels.Subgroup analyses were conducted to assess the robustness of the findings.Results The results of multivariate Cox regression analysis showed that RAR is an independent risk factor affecting the 28 d prognosis of SA-AKI patients(HR=1.058,P<0.001).Smooth curve fitting showed a positive correlation between 28 d mortality rate and RAR in SA-AKI patients.Meanwhile,Kaplan Meier survival curve analysis showed that the 28 d mortality rate in the high RAR level group was significantly higher than that in the low RAR level group(P<0.001).Subgroup analyses confirmed that RAR was a risk factor for 28 d mortality in subgroups stratified by gender,age,race,oral angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists use,acute respiratory failure,atrial fibrillation,and diabetes mellitus.Conclusion An elevated RAR is independently associated with a higher risk of short-term mortality in patients with SA-AKI.RAR may have certain prognostic value for the short-term outcome of SA AKI patients.
作者
凌晓晶
吕子文
范德墉
LING Xiaojing;LYU Ziwen;FAN Deyong(Department of Nephrology,Huzhou Central Hospital(Affiliated Huzhou Hospital of Zhejiang University School of Medicine),Huzhou 313000,China;不详)
出处
《浙江医学》
2025年第23期2515-2520,共6页
Zhejiang Medical Journal
