急性呼吸窘迫综合征患者的乳酸白蛋白比值与短期死亡率之间的关系

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-09-26 DOI:10.1016/j.jclinane.2024.111632

He-Xuan Wang , Xue-Hua Huang , Li-Qing Ma , Zhou-Jing Yang , Hai-Lian Wang , Bo Xu , Meng-Qiang Luo

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引用次数: 0

摘要

研究目的乳酸白蛋白比值（LAR）已被证实是脓毒症、心力衰竭和急性呼吸衰竭的有效预后指标。然而，LAR 与急性呼吸窘迫综合征（ARDS）患者死亡率之间的关系仍不明确。我们旨在评估 LAR 对 ARDS 患者的预测价值。干预措施我们根据主要研究终点（28 天全因死亡率）将患者分为两个亚组：28 天存活者和 28 天未存活者。措施采用多变量 Cox 回归、受体运算特征（ROC）和 Kaplan-Meier 生存分析来研究 LAR 与 ARDS 患者短期死亡率之间的关系。多变量 Cox 回归分析显示，LAR 是 28 天死亡率的独立预测因素（HR 1.11，95 %CI：1.06-1.16，P < 0.001）。在 ROC 中，LAR 的曲线下面积（AUC）为 70.34 %（95 %CI：66.53 % - 74.15 %），与乳酸（AUC = 68.00 %，P = 0.0007）或白蛋白（AUC = 63.17 %，P = 0.002）相比，LAR 的区分度明显更高。LAR 的 AUC 为 73.44 %（95 %CI：69.84 % - 77.04 %，P = 0.21），也不逊色于 SAPSII。此外，Kaplan-Meier 生存分析显示，高 LAR（>；临界值为 0.9055）的 ARDS 患者 28 天总死亡率（P <；0.001）和院内死亡率（P <；0.001）明显更高。结论我们证实 LAR 与 28 天死亡率之间存在正相关。结论我们证实 LAR 与 28 天死亡率呈正相关，这为麻醉师和重症监护医生提供了比 SAPSII 更方便的工具，但在及时发现预后不良的 ARDS 患者方面并无优势。

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Association between lactate-to-albumin ratio and short-time mortality in patients with acute respiratory distress syndrome

Study objective

The lactate-to-albumin ratio (LAR) has been confirmed to be an effective prognostic marker in sepsis, heart failure, and acute respiratory failure. However, the relationship between LAR and mortality in patients with acute respiratory distress syndrome (ARDS) remains unclear. We aim to evaluate the predictive value of LAR for ARDS patients.

Design

A retrospective cohort study.

Setting

Medical Information Mart for Intensive Care IV (v2.2) database.

Patients.

769 patients with acute respiratory distress syndrome(ARDS).

Interventions

We divided the patients into two subgroups according to the primary study endpoint (28-days all-cause mortality): the 28-day survivors and the 28-day non-survivors.

Measures

Multivariate Cox Regression, Receiver Operator Characteristic (ROC) and Kaplan–Meier survival analysis were used to investigate the relationship between LAR and short-time mortality in patients with ARDS.

Main results

The 28-day mortality was 38 % in this study. Multivariable Cox regression analysis showed that LAR was an independent predictive factor for 28-day mortality (HR 1.11, 95 %CI: 1.06–1.16, P < 0.001). The area under curve (AUC) of LAR in the ROC was 70.34 % (95 %CI: 66.53 % - 74.15 %) that provided significantly higher discrimination compared with lactate (AUC = 68.00 %, P = 0.0007) or albumin (AUC = 63.17 %, P = 0.002) alone. LAR was also not inferior to SAPSII with the AUC of 73.44 % (95 %CI: 69.84 % - 77.04 %, P = 0.21). Additionally, Kaplan-Meier survival analysis displayed that ARDS patients with high LAR (> the cut-off value 0.9055) had a significantly higher 28-day overall mortality rate (P < 0.001) and in-hospital mortality rate (P < 0.001). However, patients in high LAR group had shorter length of hospital stay (P < 0.001), which might be caused by higher in-hospital mortality.

Conclusions

We confirmed that there was a positive correlation between LAR and 28-day mortality. This could provide anesthesiologists and critical care physicians with a more convenient tool than SAPSII without being superior for detecting ARDS patients with poor prognosis timely.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.