乳酸白蛋白比指数与急性肾损伤合并心脏手术的发生及预后相关

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-07-01 DOI:10.1016/j.ijcha.2025.101734

Congying Wang , Xin Sun , Kun Chen , Yaqing Shi , Lili Wang , Shuxia Chen , Dehua Li , Jian Gu

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引用次数: 0

摘要

乳酸-白蛋白比（LAR）是一种与危重疾病预后不良相关的新型生物标志物。然而，其与心脏手术相关急性肾损伤（AKI）和预后的关系尚不清楚。本研究旨在利用MIMIC数据库中的数据来研究这种关系。方法对11624例在ICU住院的成人心脏手术患者进行回顾性队列研究。采用Logistic回归、限制性三次样条（RCS）分析和亚组分析评估LAR对AKI发生和不良结局的预测价值。结果11624例患者中，5965例发生AKI。虽然AKI患者的LAR浓度较高，但在对潜在混杂因素进行多因素调整后，这种关联并未持续存在。Logistic回归显示LAR与住院和ICU死亡率独立相关，即使在调整潜在混杂因素后也是如此。RCS分析显示AKI患者LAR升高与死亡风险增加之间存在非线性关系。相关分析表明，LAR与住院和ICU住院时间较长以及SOFA评分较高有关。亚组分析一致显示，LAR升高与老年人、女性以及伴有或不伴有高血压、慢性肾病、糖尿病或慢性心力衰竭的患者死亡风险增加相关。结论在心脏手术相关急性肾损伤患者中，尤其是瓣膜手术患者，LAR水平升高与死亡风险增加相关，但与急性肾损伤的发生无关。需要进一步的验证来确认其预测作用。

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Lactate-to-albumin ratio index correlates with the occurrence and prognosis of acute kidney injury complicated by cardiac surgery

Background

The lactate-to-albumin ratio (LAR) is a novel biomarker associated with poor prognosis in critical illnesses. However, its relationship with cardiac surgery associated acute kidney injury (AKI) and prognosis remains unclear. This study aimed to investigate this relationship using data from the MIMIC database.

Methods

A retrospective cohort study was conducted on 11,624 adult cardiac surgery patients admitted to the ICU. Logistic regression, restricted cubic spline (RCS) analysis, and subgroup analysis were used to assess the predictive value of LAR for AKI occurrence and adverse outcomes.

Results

Of the 11,624 patients, 5,965 developed AKI. While LAR concentrations were higher in AKI patients, this association did not persist after multivariate adjustment for potential confounder. Logistic regression showed that LAR was independently associated with in-hospital and ICU mortality, even after adjusting for potential confounders. RCS analysis revealed a non-linear relationship between elevated LAR and increased mortality risk in AKI patients. Correlation analyses demonstrated that LAR was associated with longer hospital and ICU stays and higher SOFA scores. Subgroup analyses consistently showed that elevated LAR was associated with increased mortality risk in older adults, females, and patients with or without hypertension, chronic kidney disease, diabetes, or chronic heart failure.

Conclusions

Among patients with acute kidney injury related to cardiac surgery, especially in those undergoing valve surgery, elevated LAR levels are associated with an increased risk of death, but not with the occurrence of acute kidney injury. Further validation is needed to confirm its predictive role.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.