基于白蛋白的三种比值指标对中老年危重症消化道出血患者30 d病死率的预测价值

Predictive value of three albumin-based ratio indices for 30-day mortality in middle-aged and elderly critically ill patients with gastrointestinal bleeding

中文关键词: 中老年  消化道出血  重症监护病房  白蛋白  乳酸  预后

英文关键词: middle-aged and elderly  gastrointestinal bleeding  intensive care unit  albumin  lactate  prognosis

中文摘要:

      目的 比较乳酸/白蛋白比值(LAR)、红细胞分布宽度/白蛋白比值(RAR)和尿素氮/白蛋白比值(BAR)在预测中老年危重症消化道出血(GIB)患者30 d病死率中的价值.方法 选取MIMIC-IV 3.1数据库中主要诊断为GIB的118例中老年危重症患者的临床资料,根据30 d内生存状态分为死亡组(n=46)和生存组(n=72).采用Logistic回归方法分析死亡风险因素,利用ROC曲线下面积(AUC)评估LAR、RAR和BAR的预测效能,并通过Kaplan-Meier曲线分析不同LAR水平下的生存差异.结果 纳入研究的118例患者,共46例在30 d内死亡,病死率为39.0％.死亡组LAR高于生存组,差异有统计学意义(P＜0.05);而2组患者的RAR和BAR差异无统计学意义(P＞0.05).Logistic回归分析结果显示,LAR 是死亡的独立危险因素(OR=3.817,95％CI:1.987～8.745,P＜0.001).LAR 的 AUC 为 0.764(95％CI:0.674～0.854),高于 RAR(AUC=0.589,95％CI:0.483～0.695,P=0.004)与BAR(AUC=0.602,95％CI:0.496～0.708,P=0.025).Kaplan-Meier分析结果显示,LAR＞1.24的患者生存率显著降低(x2=56.12,P＜0.001).结论 在基于白蛋白的三种比值指标(LAR、RAR和BAR)中,LAR对中老年危重症GIB患者30 d病死率的预测效能最佳,具有较高临床价值,仍需多中心研究验证其稳定性与通用性.

英文摘要:

      Objective To compare the value of the lactate/albumin ratio(LAR),red blood cell distribution width/al-bumin ratio(RAR),and blood urea nitrogen/albumin ratio(BAR)in predicting 30-day mortality in middle-aged and elderly critically ill patients with gastrointestinal bleeding(GIB).Methods The clinical data of 118 middle-aged and elderly critically ill patients with a primary diagnosis of GIB were extracted from the MIMIC-Ⅳ v3.1 database.Patients were divided into death group(n=46)and survival group(n=72)based on their 30-day survival status.Logistic regression was used to identify inde-pendent risk factors for mortality.The predictive performance of LAR,RAR and BAR was assessed using the area under the re-ceiver operating characteristic curve(AUC).Survival differences based on LAR level were analyzed with Kaplan-Meier curves.Results Among the 118 patients included,46 died within 30 days,resulting in a mortality rate of 39.0％.The LAR in the death group was significantly higher than that in the survival group(P＜0.05),while no significant differences were found in RAR and BAR between the two groups(P＞0.05).Logistic regression analysis identified LAR as an independent risk factor for mortality(OR=3.817,95％CI:1.987-8.745,P＜0.001).The AUC of LAR was 0.764(95％CI:0.674-0.854),which was significantly higher than those of RAR(0.589,95％CI;0.483-0.695,P=0.004)and BAR(0.602,95％CI:0.496-0.708,P=0.025).Kaplan-Meier analysis showed that patients with LAR＞1.24 had a significantly lower survival rate(x2=56.12,P＜0.001).Conclusion Among the three albumin-based ratio indices,LAR demonstrated the best predictive performance for 30-day mortality in middle-aged and elderly critically ill patients with GIB.It may have high clinical value,but multicenter studies are still needed to verify its stability and generalizability.