纤维蛋白原/白蛋白比值联合肺栓塞严重程度指数在急性肺血栓栓塞患者的病情诊断和预后评估的价值

The value of fibrinogen/albumin ratio combined with PESI in the diagnosis and prognosis evaluation of acute pulmonary thromboembolism patients

目的探讨纤维蛋白原/白蛋白比值(fibrinogen to albumin ratio,FAR)联合肺栓塞严重程度指数(pulmonary embolism severity index,PESI)在急性肺血栓栓塞(acute pulmonary thromboembolism,APTE)患者病情严重程度及预后评估的价值。方法回顾性研究2013年9月-2021年8月西南医科大学附属医院收治的确诊APTE住院患者,根据《肺血栓栓塞症诊治与预防指南》分为低危组、中危组、高危组;按30天预后分为存活组和死亡组。收集所有患者的一般资料和入院后2小时内的血液实验室相关检测指标,计算PESI和FAR。比较不同病情严重程度和不同预后APTE患者的FAR和PESI水平,采用logistic回归分析APTE患者30天死亡的独立危险因素,绘制受试者工作特征曲线评估FAR、PESI和FAR联合PESI预测30天死亡的敏感性、特异性和曲线下面积的差异。结果共纳入235例APTE患者,分为低危组85例(n=85)、中危组110例(n=110)、高危组40例(n=40);根据30天生存情况分为存活组192例(n=192)和死亡组43例(n=43)。不同病情严重程度APTE患者年龄、白蛋白(albumin,ALB)、高敏肌钙蛋白、D-二聚体、纤维蛋白原(fibrinogen,FIB)、FAR、PESI等的差异均有统计学意义(P<0.05)。随病情严重程度的增加,FAR呈进行性升高(P<0.05),相关性分析显示FAR与PESI呈正相关(r=0.614,P<0.05)。FIB、FAR、PESI升高和ALB降低是APTE患者30天死亡的独立危险因素(P<0.05)。FAR、PESI、FAR联合PESI均对APTE患者30天死亡具有预测价值,FAR联合PESI预测30天死亡曲线下面积最大。结论FAR与APTE患者的病情严重程度和预后相关,FAR联合PESI评估APTE患者30天预后较单用FAR或单用PESI更有价值。

Objective To investigate the value of fibrinogen to albumin ratio(FAR)combined with pulmonary embolism severity index(PESI)in the assessment of severity and prognosis of patients with acute pulmonary thromboembolism(APTE).Methods A retrospective study of hospitalized patients with confirmed APTE admitted to the Affiliated Hospital of Southwest Medical University from September 2013 to August 2021,divided into low-risk,intermediate-risk,and high-risk groups according to the Guidelines for the Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism,and divided into survival groups and death groups according to the 30-day prognosis.The general data of all patients and relevant blood laboratory tests within 2 hours after admission were collected to calculate PESI and FAR.FAR and PESI levels were compared in APTE patients with different severity of disease and different prognosis.Independent risk factors for 30-day mortality in APTE patients were analyzed using logistic regression.Subject working characteristic curves were drawn to assess the differences in sensitivity,specificity and area under the curve of FAR,PESI and FAR combined with PESI in predicting 30-day death.Results Total of 235 APTE patients were included,divided into 85 in the low-risk group,110 in the intermediate-risk group,and 40 in the high-risk group;192 in the survival group and 43 in the death group according to 30-day survival.The differences in age,albumin(ALB),high-sensitivity troponin,D-dimer,fibrinogen(FIB),FAR,and PESI of APTE patients with different disease severity were statistically significant(P<0.05).FAR increased progressively with increasing severity of disease(P<0.05),and correlation analysis showed a positive correlation between FAR and PESI(r=0.614,P<0.05).Elevated FIB,FAR,PESI and decreased ALB were independent risk factors for 30-day death in patients with APTE(P<0.05).FAR,PESI,and FAR combined with PESI all had predictive value for 30-day death in APTE patients,and FAR combined with PESI predicted the largest area under the 30-day death curve.Conclusions FAR correlated with the severity and prognosis of APTE patients.FAR combined with PESI was more valuable in assessing the 30-day prognosis of APTE patients than FAR alone or PESI alone.