血清C-反应蛋白／白蛋白比值评估成人脓毒症患者预后的回顾性研究

Retrospective analysis of serum C-reactive protein/albumin ratio for the prognosis of the adult patients with sepsis

目的探讨血清C-反应蛋白与白蛋白比值（CRP／ALB）对成人脓毒症患者预后的预测价值。方法采用回顾性研究方法，选择2013年9月至2015年9月河南省郑州大学第一附属医院重症医学科收治的年龄≥18岁且重症加强治疗病房（ICU）住院时间≥3d的脓毒症患者，根据28d预后将患者分为存活组和死亡组，分析其治疗即刻（0h）及治疗后24h、72h血清CRP、ALB和CRP／ALB的变化，绘制受试者工作特征曲线（ROC），评价不同时间点各指标对预后的预测价值。结果人选69例脓毒症患者，28d死亡28例，病死率为40．6％。两组患者基线资料均衡，死亡组人院第一个24h急性生理学与慢性健康状况评分系统Ⅱ（APACHE11）评分、序贯器官衰竭评分（SOFA）较存活组显著升高[APACHEⅡ（分）：25．18±3．18比17．88±3．20，SOFA（分）：11．71±1．78比9．17±2．38，均P〈0．05]，ICU住院时间显著延长[d：9．0（2．5）比8．0（3．0），P〈0．05]。随治疗时间延长，两组患者血清ALB逐渐升高，血清CRP及CRP／ALB逐渐下降；死亡组治疗后0、24、72hALB均明显低于存活组，CRP及CRP／ALB均明显高于存活组[ALB（g／L）：0h为23．40（4．20）比25．20（8．20），24h为24．18±4．33比28．54±4．88，72h为25．50±4．88比34．88±7．23；CRP（mg／L）：0h为179．32±34．04比159．55±36．82，24h为160．08±22．91比146．23±30．31，72h为159．36±25．81比142．53±36．30；CRP／ALB：0h为7．52±1．32比6．04±1．46，24h为6．77±1．42比5．23±1．24，72h为6．40±1．34比4．19±1．21；均P〈0．05）。ROC曲线分析显示，治疗后各时间点CRP／ALB的AUC均大于同期ALB和CRP的AUC，且有更高的敏感度和特异度；0、24、72hCRP／ALB的AUC分别为0．767、0．807、0．895，截断值分别为6．96、5．44、4．91，敏感度分别为71．4％、85．7％、89．3％，特异度分别为73．2％、63．4％、82．9％。结论成人脓毒症患者血清CRP、CRP／ALB较高及血清ALB较低均可提示预后不良，CRP／ALB对预后的预测价值明显优于单用CRP或ALB。用72hCRP／ALB评估脓毒症患者临床疗效及预后更佳。

Objective To explore the prbgnostic value of serum C-reactive protein/albumin （CRP/ALB） ratio in the adult patients with sepsis. Methods A retrospective study was conducted. Clinical data were collected from septic patients who were at least 18 years old and whose intensive care unit （ICU） lengths of stay were at least 3 days, and who were admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University in Henan Province from September 2013 to September 2015. These patients were divided into survival group and death group according to 28-day outcome. The serum CRP, ALB, and CRP/ALB ratio levels at the start of treatment （0 hour）, 24 hours and 72 hours after treatment in ICU were analyzed. And the receiver-operating characteristic （ROC） curve was plotted to assess the value of CRP, ALB and CRP/ALB ratio at different time points for predicting the outcome. Results Sixty-nine patients with sepsis were selected, among whom 28 cases were in the death group and the mortality was 40.6%. The characteristic of the baseline data in the two groups was balanced. The acute physiology and chronic health evaluation lI （APACHE II ） score and sequential organ failure assessment （SOFA） score at the first 24 hours of ICU admission in the death group were significantly higher than those in the survival group （APACHE Ⅱ score： 25.18±3.18 vs. 17.88±3.20, SOFA score： 11.71 ± 1.78 vs. 9.17±2.38, both P 〈 0.05）. And the ICU length of stay in the death group was significantly longer than that in the survival group [days： 9.0 （2.5） vs. 8.0 （3.0）, P 〈 0.05]. The ALB level increased gradually as the treatment was extended in both groups while the levels of CRP and CRP/ALB declined gradually. The ALB levels at 0, 24, 72 hours after treatment in the death group were significantly lower, and the CRP and CRP/ALB levels were significantly higher than those in survival group [ALB （g/L）： 23.40 （4.20） vs. 25.20 （8.20） at 0 hour, 24.18±4.33 vs. 28.54±4.88 at 24 hours, 25.50±4.88 vs. 34.88±7.23 at 72 hours; CRP （mg/L）： 179.32±34.04 vs. 159.55±36.82 at 0 hour, 160.08±22.91 vs. 146.23±30.31 at 24 hours, 159.36±25.81 vs. 142.53 ±36.30 at 72 hours; CRP/ALB： 7.52± 1.32 vs. 6.04± 1.46 at 0 hour, 6.77± 1.42 vs. 5.23± 1.24 at 24 hours, 6.40±1.34 vs. 4.19±1.21 at 72 hours; all P 〈 0.05]. ROC curves analysis showed that the area under ROC curves （AUC） of CRP/ALB at all time points were larger than those of CRP and ALB, with higher sensitivity and specificity; the AUC of ARP/ALB at 0, 24, 72 hours were 0.767, 0.807, 0.895, respectively; the cut-off values were 6.96, 5.44, 4.91, the sensitivity were 71.4%, 85.7% and 89.3%, and the specificity were 73.2%, 63.4% and 82.9%, respectively. Conclusions High serum CRP, CRP/ALB and low ALB in adult patients with sepsis indicate a poor prognosis, while the prognostic value of CRP/ALB is obviously better than the single value of CRP or ALB. CRP/ALB at 72 hours may be one of the best indicators for the assessment of clinical therapy and prognosis of patients with sepsis.