微量清蛋白尿对重症脓毒症患者预后的预测意义

Predictive Value of Microalbuminuria for the Prognosis of Severe Sepsis in Intensive Care Unit

目的探讨微量清蛋白尿(MAU)对重症脓毒症患者预后的预测价值。方法选取我院ICU31例重症脓毒症患者,测定入科1、24、48h的尿微量清蛋白(MA)与尿肌酐之比(ACR),分别记录为ACR0、ACR1和ACR2,记录患者入ICU后第一个48h尿MA的动态变化趋势(△ACR)。分析ACR、△ACR与急性生理和慢性健康状况评分系统(APACHEⅡ)评分、感染相关器官功能衰竭(SOFA)评分的相关性;比较ACR、△ACR与APACHEⅡ评分、SOFA评分对重症脓毒症患者ICU内死亡的预测分辨度。结果 31例患者存活23例,死亡8例。死亡组ACR2、△ACR、APACHEⅡ评分、SOFA评分较存活组均明显升高,差异有统计学意义(P<0.05)。△ACR增高组ACR2、A-PACHEⅡ评分、SOFA评分、机械通气时间及病死率均高于△ACR下降组,差异有统计学意义(P<0.05)。患者入ICU后ACR1、ACR2与APACHEⅡ评分呈正相关(P<0.05);ACR1、ACR2与SOFA评分呈正相关(P<0.05)。△ACR增高预测患者ICU内死亡的敏感度和特异度分别为75.0%和87.0%,阳性预测值和阴性预测值分别为66.7%和90.9%。ACR0、ACR1、ACR2、△ACR及APACHEⅡ评分、SOFA评分对ICU内死亡预测ROC曲线下面积分别为0.556、0.689、0.856、0.800、0.856、0.833。结论△ACR与重症脓毒症患者的预后相关,△ACR具有与APACHEⅡ评分、SOFA评分相似的死亡预测分辨度,可作为判断脓毒症患者在ICU内预后的一个早期预测指标。

Objective To explore the predictive value of microalbuminuria（MAU）for the prognosis of severe sepsis in intensive care unit（ICU）.Methods In this prospective observational study,31 patients with sever sepsis who had been admitted to ICU of Yanan Hospital of Kunming from June 2009 to February 2010 were enrolled in this study.MAU was expressed as the urinary microalbumin/urinary creatinine ratio（ACR,the normal upper threshold is 2.7mg/mmol）.Urinary samples were collected 1,24,and 48 hours after hospital admission,which were recorded as ACR0,ACR1,and ACR2,respectively.The change of the ACR during the first 48 hours was recorded as △ACR.The relationship between △ACR with the APACHEⅡ scores and the SOFA score was analyzed and the predictive values were compared.Results Of 31 patients with severe sepsis,23 survived and 8 died.△ACR,APACHEⅡ scores,and SOFA scores were significantly different between the survivors group and the death group（P〈0.05）.ACR2,APACHE II scores,SOFA scores,duration of mechanical ventilation,and case-fatality rate were significantly higher among patients with increased △ACR during the first 48 hours than than with decreased △ACR（P〈0.01）.ACR0 was positively correlated with ACR1 and ACR2 after the patients were admitted to ICU（both P〈0.05）.Also,ACR1 and ACR2 were positively correlated with APACHEⅡ scores（both P〈0.05）.The sensitivity and specificity of △ACR in predicting ICU deaths were 75.0% and 87.0%,and the positive and negative predictive values were 66.7 % and 90.9 %.The areas under ROC curves of△ACR,APACHEⅡ score and SOFA score to predictive the death in ICU were 0.800（P〈0.05）,0.856（P〈0.05）,and 0.833（P〈0.05）,respectively.Conclusion △ACR is relevant with the prognosis of severe sepsis.△ACR has similar power as APACHEⅡ score and SOFA score in predicting the outcomes of patients with severe sepsis.