优化重症监护死亡率预测：血清尿酸和APACHE II评分评估的协同价值

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-07-05 DOI:10.1016/j.jemermed.2025.07.014

Yugeng Liu , Jia Wang , Junyu Wang , Bing Wei

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引用次数: 0

摘要

榴莲酸（UA）具有抗氧化剂和促氧化剂的双重作用，其水平与保护或有害作用有关，这取决于浓度和临床情况。虽然极端的UA水平与重症监护的不良结果相关，但将UA与临床评分（如APACHE II）相结合可能会改善重症监护病房（ICU）患者的风险分层。研究目的：本回顾性队列研究探讨重症患者入院时UA水平与APACHE II评分的预后意义。方法对2015 - 2021年我院急诊重症监护室（EICU）收治的380例患者进行分析，追踪出院后28天死亡率。入院24小时内记录APACHEⅱ评分、UA、降钙素原（PCT）、c反应蛋白（CRP）、d -二聚体、肌酐（Cr）、白细胞（WBC）、血小板（PLT）等临床参数。采用多元回归模型和受试者工作特征（ROC）曲线分析进行统计评价。结果非生存组（n = 72）患者年龄明显增高（68.2±12.1 vs 62.5±15.3），p <；0.01)， APACHE II评分（24.6±7.2 vs 16.8±6.5），UA水平（456.3±178.4 vs 342.1±152.6µmol/L）与幸存者（n = 308）相比。多变量分析鉴定为APACHE II (OR = 1.32, 95% CI 1.18-1.47, p <；0.001)和UA （OR = 1.01, 95% CI 1.003-1.018, p = 0.007）作为独立的死亡率预测因子。联合UA- apache II模型的预后准确率（AUC = 0.788）优于单独使用任何一个参数(UA AUC = 0.627；Apache ii auc = 0.767)。结论UA水平可协同提高APACHEⅱ评分对EICU患者死亡率预测的预后价值。这种生物标志物组合为重症监护管理中的风险分层提供了一种潜在的临床可行方法。

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Optimizing Mortality Prediction in Critical Care: Synergistic Value of Serum Uric Acid and APACHE II Score Assessment

Background

Uric acid (UA) has dual roles as both an antioxidant and pro-oxidant, with its levels linked to either protective or harmful effects depending on concentration and clinical context. While extreme UA levels correlate with poor outcomes in critical care, integrating UA with clinical scores like APACHE II may improve risk stratification for intensive care unit (ICU) patients.

Study Objectives

This retrospective cohort study investigated the prognostic significance of admission UA levels combined with APACHE II scores in critically ill patients.

Methods

We analyzed 380 patients admitted to the Emergency Intensive Care Unit (EICU) at our Hospital from 2015 to 2021, tracking 28-day postdischarge mortality. Clinical parameters including APACHE II scores, UA, procalcitonin (PCT), C-reactive protein (CRP), D-dimer, creatinine (Cr), white blood cells (WBC), and platelets (PLT) were recorded within 24 h of admission. Multivariate regression models and receiver operating characteristic (ROC) curve analysis were employed for statistical evaluation.

Results

The nonsurvival group (n = 72) demonstrated significantly elevated age (68.2 ± 12.1 vs 62.5 ± 15.3 years, p < 0.01), APACHE II scores (24.6 ± 7.2 vs 16.8 ± 6.5), and UA levels (456.3 ± 178.4 vs 342.1 ± 152.6 µmol/L) compared to survivors (n = 308). Multivariate analysis identified APACHE II (OR = 1.32, 95% CI 1.18–1.47, p < 0.001) and UA (OR = 1.01, 95% CI 1.003–1.018, p = 0.007) as independent mortality predictors. The combined UA-APACHE II model achieved superior prognostic accuracy (AUC = 0.788) compared to either parameter alone (UA AUC = 0.627; APACHE II AUC = 0.767).

Conclusions

Admission UA levels synergistically enhance the prognostic value of APACHE II scores for mortality prediction in EICU patients. This biomarker combination provides a potentially clinically actionable approach for risk stratification in critical care management.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine