早期血浆白蛋白变异对ICU重症急性胰腺炎患者预后评估的价值

Relationship Between Early Serum Albumin Variation and Prognosis in Patients with Severe Acute Pancreatitis Treated in ICU

目的探讨ICU重症急性胰腺炎(severe acute pancreatitis,SAP)患者早期血浆白蛋白变异对患者病情严重程度及预后的预测价值。方法对2005年7月至2010年6月收治的SAP患者进行回顾性分析,将纳入对象根据预后分为生存组(n=131)及死亡组(n=108),分析比较两组患者入ICU基本情况、预后、血浆白蛋白水平及变异等,并进行logistic回归分析。结果两组患者年龄、急性生理和慢性健康评价指标Ⅱ(acute physiology andchronic health evaluationⅡ,APACHEⅡ)评分、Ranson评分、序贯器官衰竭评估(sequential organ failureassessment,SOFA)评分、入ICU 24h内血浆白蛋白下降值及其变异度,差异均有统计学意义(P均<0.01)。而两组患者男女比例、入ICU 24h内血浆白蛋白水平、发病到入院时间、发病到入ICU时间差异无统计学意义(P>0.05)。对入ICU 24h内血浆白蛋白下降值及变异度绘制受试者工作特征曲线(ROC曲线),曲线下面积分别为0.728和0.742,预测患者死亡的最佳截断值分别为4.25g/L(敏感度61.45%,特异度81.67%)和13.5%(敏感度62.65%,特异度78.33%)。经logistic回归分析发现,入ICU 24h内血浆白蛋白下降值及变异度与ICU重症急性胰腺炎患者死亡相关,而且,随着下降值及变异度的增大,死亡率逐渐升高。结论入ICU 24h内血浆白蛋白下降值及其变异度是ICU重症急性胰腺炎患者死亡的早期危险因素。

Objective To investigate the relationship between serum albumin variation within 24 hours of ICU admission and prognosis in critically ill patients with sever acute pancreatitis（SAP）. Methods We retrospectively analyzed all the clinical data of the patients with SAP treated in ICU from Jul. 2005 to Jun. 2010. The patients were divided into two groups, survival group （n= 131） and death group （n = 108）. Clinical and laboratory data, outcomes, and serum albumin within 24 hours after admission to ICU of those patients were evaluated respectively, and Logistic regression analysis was performed. Results Significant differences were existed between two groups （P〈0.01） in average age, the score of acute physiology and chronic health evaluation II （APACHE II ）, Ranson criteria, the score of sequential organ failure assessment （SOFA）, and albumin variation within 24 hours （Serum albumin descent degree and ratio in early stage）. However, sex ratio, mean serum albumin concentration within 24 hours, and onset time did not have significant differences （P〉~0. 05）. The area under ROC curve for albumin variation within 24 hours were 0. 728 and 0. 742, the best cut-off values were 4. 25 g/L（sensitivity 61. 45%, specificity 81. 67%） and 13. 5% （sensitivity 62. 65%, specificity 78. 33%）, respectively. Multiple logistic regression analysis showed that albumin variation within 24 hours was associated with death. Conclusion The albumin variation within 24 hours was the risk factors for poor prognosis of critically ill SAP in early stage.