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白蛋白校正阴离子间隙对脓毒症休克患者预后的预测价值

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目的 探讨白蛋白校正阴离子间隙(ACAG)对脓毒症休克(SS)患者预后的预测价值.方法 从美国重症监护医学信息数据库中获取2008年至2019年入住ICU的2511例成人SS患者的数据.根据90 d预后情况,将患者分为存活组和死亡组;根据ACAG水平,将患者分为低ACAG组(12~20 mmol/L)和高ACAG组(>20 mmol/L).绘制Kaplan-Meier生存曲线,并使用log-rank检验比较低ACAG组和高ACAG组患者30和90 d累积生存率.采用限制性立方样条(RCS)分析SS患者ACAG水平与90 d全因死亡风险的关系.采用多因素Cox回归分析ACAG水平与SS患者30、90 d全因死亡的关系.结果 2 511例SS患者,90 d全因死亡率为45.56%.存活组和死亡组患者年龄、序贯器官衰竭评估评分、简化的急性生理评分Ⅱ、乳酸、阴离子间隙、白蛋白、ACAG、RBC、PLT、TBil、尿素氮、肌酐、血总钙、血磷、使用血浆比例、合并恶性肿瘤、心脏骤停、急性肾损伤、慢性肾脏病比例、使用去甲肾上腺素比例、机械通气比例、连续性肾脏替代治疗比例比较,差异均有统计学意义(均P<0.05).高ACAG组患者30和90 d全因死亡率分别为42.10%和51.05%,均明显高于低ACAG组的29.73%和37.74%,差异均有统计学意义(均P<0.01).Kaplan-Meier生存曲线显示,低ACAG组患者30和90 d累积生存率均高于高ACAG组,差异均有统计学意义(均P<0.01).RCS分析显示,ACAG与患者90 d全因死亡风险整体呈非线性趋势关系(P=0.004).多因素Cox回归分析显示,入ICU时高ACAG水平(>20 mmol/L)是SS患者30和90 d全因死亡的独立危险因素[HR=1.169(95%CI:1.001~1.365)和HR=1.181(95%CI:1.029~1.357)].结论 入ICU时高ACAG水平(>20 mmol/L)对SS患者预后不良具有一定的预测价值,有助于临床医生对SS患者进行预后评估,以便及时、准确地救治,提高存活率.
Predictive value of albumin-corrected anion gap in the prognosis of patients with septic shock
Objective To explore the predictive value of albumin-corrected anion gap(ACAG)in the prognosis of patients with septic shock(SS).Methods The clinical data of 2 511 adult patients with SS in the United States Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ,version 2.0;2008-2019)Database were retrospectively analyzed.According to the 90-day prognosis,patients were divided into survival group and death group.According to the ACAG value,patients were divided into low ACAG group(12-20 mmol/L)and high ACAG group(>20 mmol/L).Kaplan-Meier survival curves were drawn,and the log-rank test was used to compare the 30-day and 90-day cumulative survival rates of patients in the low and high ACAG groups.The relationship between ACAG and 90 d all-cause mortality was analyzed by restricted cubic spline(RCS).Multivariate Cox regression model was used to analyze the relationship between ACAG level and 30-day and 90-day all-cause mortality in SS patients.Results A total of 2 511 SS patients were finally included,and the 90-day all-cause mortality rate was 45.56%.There were significant differences between the survival group and the death group in age,Sequential Organ Failure Assessment Score,simplified Acute Physiology Score Ⅱ,lactate,anion gap,albumin,ACAG,red blood cells,platelets,total bilirubin,urea nitrogen,creatinine,total blood calcium,blood phosphorus,ratio of norepinephrine usage,ratio of plasma usage,ratio of mechanical ventilation,ratio of continuous renal replacement therapy,combined malignant tumors,cardiac arrest,acute kidney injury,and ratio of chronic kidney disease(all P<0.05).The 30-day and 90-day all-cause mortality rates of the low ACAG group were 29.73%and 37.74%,respectively,which were both significantly lower than those of the high ACAG group as 42.10%and 51.05%,respectively(both P<0.01).The Kaplan-Meier survival curve showed that compared with the high ACAG group,the 30-day and 90-day cumulative survival rates of the low ACAG group were higher,and the differences were statistically significant(both P<0.01).RCS analysis showed an non-linear trend relationship between ACAG and 90-day all-cause mortality risk(P=0.004).Multivariate Cox regression analysis showed that increased ACAG level(>20 mmol/L)while admitted to ICU was an independent risk factor for 30-day and 90-day all-cause mortality of patients with SS[HR=1.169(95%CI:1.001-1.365)and HR=1.181(95%CI:1.029-1.357)].Conclusion High ACAG levels(>20 mmol/L)at ICU admission have certain predictive value for poor prognosis in SS patients,which is helpful for clinicians to evaluate the prognosis of SS patients and timely and accurately treat patients to improve the survival rate.

Albumin-corrected anion gapSeptic shockPrognosis

汪永斌、叶莉莉、姬晓伟、谢波

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313000 湖州市中心医院(浙江中医药大学第五临床医学院)重症医学科

白蛋白校正阴离子间隙 脓毒症休克 预后

浙江省医药卫生科技计划项目

2023KY311

2024

浙江医学
浙江省医学会

浙江医学

CSTPCD
影响因子:0.428
ISSN:1006-2785
年,卷(期):2024.46(17)
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