乳酸/白蛋白比值对老年脓毒症并发多器官功能障碍综合征患者的预后评估价值

Prognostic value of lactate/albumin ratio in the elderly sepsis patients complicated with multiple organ dysfunction syndrome

目的探讨乳酸/白蛋白比值(Lac/Alb)对老年脓毒症并发多器官功能障碍综合征(MODS)患者的预后评估价值。方法回顾性研究2015年1月至2017年6月海南省人民医院急诊科和ICU收治的老年脓毒症并发MODS患者162例,根据MODS患者入院后14 d的生存情况,将其分为2组:存活组(n=56)和死亡组(n=106)。检测2组患者治疗后0、24、48 h的乳酸(Lac)、白蛋白(Alb)及Lac/Alb,并记录入院时急性生理学与慢性健康状况量表系统Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分情况。采用SPSS 19.0软件进行数据处理。应用受试者工作特征(ROC)曲线分析Lac、Alb及Lac/Alb对MODS患者的预后评估价值。相关性分析采用Pearson相关分析。结果死亡组0、24、48 h的Lac[(7.84±2.65)vs(4.58±1.52)mmol/L,(9.23±4.16)vs(3.60±1.18)mmol/L,(10.58±4.72)vs(2.14±0.85)mmol/L]及Lac/Alb[(0.38±0.17)vs(0.19±0.12),(0.51±0.20)vs(0.14±0.08),(0.67±0.23)vs(0.08±0.03)]均显著高于存活组(P<0.05),而Alb[(22.26±4.35)vs(25.38±4.72)g/L,(19.15±4.07)vs(27.14±5.20)g/L,(16.30±3.52)vs(31.73±6.82)g/L]显著低于存活组(P<0.05)。ROC曲线显示,Lac/Alb48h的最佳截断点为0.45时,预测MODS患者预后的敏感度(93.6%)和特异度(86.5%)最好。Lac/Alb48h与APACHEⅡ(r=0.725)和SOFA(r=0.806)评分呈显著正相关(P<0.01)。结论 Lac/Alb与MODS患者的病情严重程度及预后密切相关,Lac/Alb48h预测MODS患者预后的价值较高。

Objective To investigate the prognostic value of the ratio of lactic acid to albumin(Lac/Alb)in elderly patients with sepsis complicated with multiple organ dysfunction syndrome(MODS).Methods A retrospective study was performed on 162 elderly patients with sepsis complicated with MODS who admitted in the First Aid Center and ICU of our hospital from January 2015 to June 2017.They were divided into survival group(n=56)and death group(n=106)according to their 14-day survival.The changes of Lac,Alb and Lac/Alb ratio in 0,24 and 48 h after treatment were studied,and the scores of Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)and Sequential Organ Failure Assessment(SOFA)at admission were recorded in the 2 groups.SPSS statistics 19.0 was used for data processing.Receiver operating characteristic(ROC)curve was used to analyze the prognostic value of Lac,Alb and Lac/Alb ratio in MODS patients.Pearson correlation analysis was also used.Results At 0,24 and 48 h after treatment,the death group had significantly higher Lac[(7.84±2.65)vs(4.58±1.52)mmol/L,(9.23±4.16)vs(3.60±1.18)mmol/L,(10.58±4.72)vs(2.14±0.85)mmol/L]and Lac/Alb ratio[(0.38±0.17)vs(0.19±0.12),(0.51±0.20)vs(0.14±0.08),(0.67±0.23)vs(0.08±0.03)],but obviously lower Alb[(22.26±4.35)vs(25.38±4.72)g/L,(19.15±4.07)vs(27.14±5.20)g/L,(16.30±3.52)vs(31.73±6.82)g/L],when compared with the survival group(P<0.05).The results of ROC curve showed that when the best cut-off value of Lac/Alb ratio at 48 h was 0.45,the ratio well predicted the prognosis of MODS with a sensitivity of 93.6%and a specificity of 86.5%.Lac/Alb ratio at 48 h was positively correlated to APACHEⅡ(r=0.725,P<0.01)and SOFA scores(r=0.806,P<0.01).Conclusion Lac/Alb ratio is closely related to the severity and prognosis of patients with MODS,and the ratio at 48 h is of higher value in predicting the prognosis.