白蛋白校正阴离子间隙对严重慢性肾病伴脓毒症的预后价值:与死亡率和临床结果的关系

IF 3.4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Decai Wang, Ruizi Shi, Tao Wang, Han Li, Jianjun Wang
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引用次数: 0

摘要

目的:白蛋白校正阴离子间隙(ACAG)已成为危重患者预后的生物标志物。由于免疫功能障碍、慢性炎症和代谢紊乱,慢性肾脏疾病(CKD)合并脓毒症患者的死亡风险明显增加。本研究旨在探讨CKD和脓毒症危重患者ACAG水平与死亡率结局(包括ICU、住院、14天、28天和90天死亡率)之间的关系。方法:对贝斯以色列女执事医疗中心ICU收治的3459例CKD合并脓毒症危重患者进行分析。根据确定的最佳阈值将患者分为低acag和高acag两组。采用多变量Cox比例风险模型检验ACAG与ICU死亡率、住院死亡率以及14天、28天和90天死亡率之间的关系。采用受试者工作特征(ROC)曲线评价ACAG对该特定患者群体入院后短期和长期死亡率的预测能力、敏感性、特异性和曲线下面积。此外,还进行了限制性三次样条(RCS)分析,以探讨ACAG与这些死亡率结果之间潜在的剂量-反应关系。进行亚组分析以评估患者特征如何影响ACAG的预后价值。结果:与低ACAG组(n = 2482)相比,高ACAG组(n = 977)的ICU死亡率、住院死亡率以及14天、28天和90天死亡率均显著高于低ACAG组(n = 2482)。多因素Cox回归分析显示,ACAG水平升高与ICU死亡率、住院死亡率以及14天、28天和90天死亡率的较高风险独立相关。RCS分析发现ACAG水平与ICU死亡风险、住院死亡率以及14、28和90天死亡率之间存在显著的线性关系。ROC曲线分析表明,与阴离子间隙相比,ACAG对该患者群体的预后有更好的预测能力。亚组分析结果表明,ACAG与大多数特定患者亚组之间无统计学意义的相互作用。结论:ACAG可作为CKD合并脓毒症危重患者的独立预后指标。ACAG作为一种易于获取且具有成本效益的生物标志物,可以帮助早期识别高危患者,优化患者管理,改善患者预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic value of albumin-corrected anion gap in severe chronic kidney disease with sepsis: association with mortality and clinical outcomes.

Objective: Albumin-corrected anion gap (ACAG) has emerged as a prognostic biomarker for critically ill patients. The mortality risk in patients with chronic kidney disease (CKD) complicated by sepsis is markedly increased Due to immune dysfunction, chronic inflammation, and metabolic disturbances. This study sought to investigate the associations between ACAG levels and mortality outcomes, including ICU, in-hospital, 14-day, 28-day, and 90-day mortality, in critically ill patients with CKD and sepsis.

Methods: A total of 3459 critically ill patients with CKD and sepsis who were admitted to the ICU at Beth Israel Deaconess Medical Center were included in the analysis. These patients were categorized into two groups-lower and higher ACAG-based on the determined optimal threshold. Multivariate Cox proportional hazards models were employed to examine the associations between ACAG and ICU mortality, in-hospital mortality, as well as 14-, 28-, and 90-day mortality. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability, sensitivity, specificity, and area under the curve of ACAG for short-term and long-term mortality after admission in this specific patient population. Additionally, restricted cubic spline (RCS) analysis was conducted to explore the potential dose-response relationship between ACAG and these mortality outcomes. Subgroup analyses were conducted to assess how patient characteristics affect the prognostic value of ACAG.

Results: Compared with the lower ACAG group (n = 2482), the higher ACAG group (n = 977) exhibited significantly higher ICU mortality, in-hospital mortality, and 14-, 28-, and 90-day mortality. Multivariate Cox regression analysis revealed that elevated ACAG levels were independently Linked to a higher risk of ICU mortality, in-hospital mortality, as well as 14-, 28-, and 90-day mortality rates. RCS analysis identified significant Linear relationships between ACAG levels and the risk of ICU death, in-hospital mortality, as well as mortality at 14, 28, and 90 days. ROC curve analysis indicated that ACAG had superior predictive ability for prognosis in this patient population compared to anion gap. The results of the subgroup analyses indicated that there were no statistically significant interactions between ACAG and most specific patient subgroup.

Conclusion: ACAG serves as an independent prognostic marker for critically ill patients suffering from CKD and sepsis. As an easily accessible and cost-effective biomarker, ACAG can aid in the early identification of high-risk patients, optimize patient management, and improve patient outcomes.

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来源期刊
European Journal of Medical Research
European Journal of Medical Research 医学-医学:研究与实验
CiteScore
3.20
自引率
0.00%
发文量
247
审稿时长
>12 weeks
期刊介绍: European Journal of Medical Research publishes translational and clinical research of international interest across all medical disciplines, enabling clinicians and other researchers to learn about developments and innovations within these disciplines and across the boundaries between disciplines. The journal publishes high quality research and reviews and aims to ensure that the results of all well-conducted research are published, regardless of their outcome.
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