胆汁淤积和缺氧性肝炎对ICU患者预后的影响:基于重症监护-Ⅲ数据库的回顾性分析

Effects of cholestasis and hypoxic hepatitis on prognosis of ICU patients:a retrospective study based on MIMIC Ⅲ database

目的肝脏相关指标异常在危重患者中是一种常见的现象,但是危重症引起的胆汁淤积和缺氧性肝炎对患者预后的影响尚不清楚。本研究旨在探讨胆汁淤积和缺氧性肝功能障碍对ICU患者预后的影响。方法利用重症监护-III(MIMIC-III)数据库提取2001年至2011年首次收入ICU的患者基本信息及疾病相关数据进行回顾性研究。所有病例分组为缺氧性肝炎组、胆汁淤积组及对照组;胆汁淤积定义为胆红素>2 mg/d L,碱性磷酸酶升高为正常值上限(120 U/L)的两倍,转氨酶正常。以28 d病死率为主要结局指标分析胆汁淤积和缺氧性肝功能障碍对ICU患者预后的影响。结果共有5852例患者纳入研究,胆汁淤积性和缺氧性肝功能障碍发生率分别为31.9%(1869/5852)和17.9%(1046/5852);胆汁淤积组和对照组之间死亡率无统计学差异。与对照组相比,缺氧性肝炎组有更高的28 d病死率(46%vs 35%,P<0.01),住院病死率(40%vs 31%,P<0.01),以及ICU病死率(35.7%vs 22.2%,P<0.01)。Logistic回归显示,乳酸、天冬氨酸转氨酶、国际化标准比值是患者收入ICU后28 d内死亡的独立危险因素。结论ICU患者早期胆汁淤积性肝功能障碍的发生率高于缺氧性肝炎,但不增加患者的死亡率,提示胆汁淤积性肝功能障碍可能是肝脏对危重疾病的早期适应性改变。

Objective Abnormalities of liver-related indices are common in ICU patients,but the effects of cholestasis and hypoxic hepatitis in critically ill patients remains unclarified.The purpose of this study was to investigate the effects of cholestasis and hypoxic liver dysfunction on the prognosis of ICU patients.Methods A retrospective study was conducted based on the data of patients admitted to the ICU for the first time between 2001 and 2011 archived in the MIMIC-III database.The patients were divided into cholestasis,hypoxic hepatitis and control groups,and their 28-day case fatality rate as the primary outcome was compared among the groups.Results A total of 5852 ICU patients were included in the analysis.The incidence of cholestasis and hypoxic liver dysfunction was 31.9%(1869/5852)and 17.9%(1046/5852),respectively.There was no significant difference in 28-day case fatality rate between cholestasis group and the control group.Compared with the control group,the patients with hypoxic hepatitis had a significantly higher 28-day case fatality rate(46%vs 35%,P<0.01),a higher hospital case fatality rate(40%vs 31%,P<0.01),and a higher ICU case fatality rate(35.7%vs 22.2%,P<0.01).Logistic regression analysis showed that lactic acid(LAC),aspartate transaminase(AST),and international standard ratio(INR)were independent risk factors for 28-day case fatality rate.Conclusion The incidence of cholestatic liver dysfunction is higher than that of hypoxic hepatitis,but it does not increase the 28-day case fatality rate of the ICU patients,suggesting that cholestatic liver dysfunction may be the early adaptation of the liver to critical diseases.