血清胆红素水平对腹膜透析患者预后的判断价值

Predictive Value of Serum Bilirubin Level in Patients with Peritoneal Dialysis

【目的】观察血清胆红素水平与腹膜透析(PD)患者病死率的相关性,并分析其对患者预后的判断价值。【方法】选择2015年5月30日至2017年5月30日收治的140例维持性PD患者,检测其透析6个月时血总胆红素水平,记录患者基线临床及实验室资料。随访至2019年5月30日,随访终点为全因死亡。采用ROC曲线确定血胆红素最佳截断点,分析血总胆红素与死亡相关性及其对病死率的预测价值。【结果】随访时间6〜42个月,中位随访时间34个月,共死亡33例,血总胆红素平均水平为(5.3±1.4)μmol/L。血胆红素水平预测全因死亡的ROC曲线下面积(AUC)为0.69(P=0.012),最佳截断点为3.3 μmol/L,灵敏度为67.5%,特异度为69.1%。胆红素低值组32例(<3.3 μmol/L),胆红素高值组108例(≥3.3 μmol/L)。胆红素低值组白蛋白、血钙、血红蛋白水平低于胆红素高值组(P<0.05)。胆红素低值组累积生存率低于胆红素高值组(P<0.05)。多因素分析显示,尿酸、血糖、透析充分性、年龄、胆红素是维持性PD全因死亡的独立危险因素(P<0.05)。【结论】血胆红素<3.3 μmol/L的维持性PD患者病死率较高,血胆红素水平是预测PD患者全因死亡的有效生物学标志物。

【Objective】To investigate the correlation between serum bilirubin level and mortality in peritoneal dialysis(PD)patients and analyze its predictive value for prognosis of PD patients.【Methods】A total of 140 patients with maintenance PD in our hospital from May 30,2015 to May 30,2017 were selected for the study.The blood bilirubin level was measured at 6 months of dialysis.The baseline clinical data and laboratory results were recorded.The termination time of follow-up was May 30,2019,and the end point of follow-up was all-cause death.The ROC curve were used to determine the best cut-off point of blood bilirubin.The correlation between blood bilirubin and death were revealed and its predictive value for mortality were analyzed.【Results】The follow-up time was 6-42 months and the median follow-up time was 34 months.A total of 33 patients died.The average level of blood bilirubin was(5.3±1.4)μmol/L.The area under the ROC curve(AUC)of blood bilirubin predicted allcause mortality was 0.69(p=0.012),the best cut-off point of blood bilirubin was 3.3μmol/L,the sensitivity was 67.5%,and the specificity was 69.1%.There were 32 patients with bilirubin low value(<3.3μmol/L)and 108 patients with high bilirubin group(≥3.3μmol/L).The albumin,serum calcium and hemoglobin levels in the low bilirubin group were lower than those in the high bilirubin group(P<0.05).The cumulative survival rate of low bilirubin group was lower than that of the high bilirubin group( P<0.05).Uric acid,blood glucose,dialysis adequacy,age,and bilirubin were independent risk factors for all-cause mortality in maintenance PD patients(P< 0.05).【Conclusion】The mortality of maintenance PD with blood bilirubin<3.3μmol/L is high.The blood bilirubin level is an effective biomarker for predicting all-cause death in patients with PD.