血清C反应蛋白与白蛋白比值对老年急性心力衰竭机械通气患者撤机结局的预测价值

The value of serum C-reactive protein to albumin ratio for predicting weaning outcome in elderly patients with acute heart failure undergoing mechanical ventilation

目的分析血清C反应蛋白与白蛋白比值(CRP/ALB)预测老年急性心力衰竭机械通气患者撤机结局的价值。方法选取2017年2月至2019年2月永康市第一人民医院接受机械通气治疗的老年急性心力衰竭患者142例,按照撤机结局分为撤机失败组(42例)和撤机成功组(100例),收集包括血清C反应蛋白(CRP)和白蛋白(ALB)在内的临床数据资料,计算CRP/ALB比值。采用logistic回归方程分析撤机失败的相关因素,ROC曲线用于分析CRP/ALB预测撤机结果价值。结果撤机失败组糖尿病比例、血肌酐、氨基末端脑钠肽前体(NT-proBNP)水平高于撤机成功组,血红蛋白(Hb)、左心室射血分数(LVEF)、二尖瓣舒张早期最大速度(E峰)/心房收缩期最大速度(A峰)(E/A)低于撤机成功组,差异均有统计学意义(均P<0.05)。自主呼吸测试(SBT)前撤机失败组CRP[(14.76±5.56)mg/L]、CRP/ALB(0.45±0.15)高于撤机成功组[(11.34±4.22)mg/L、0.32±0.13],ALB[(32.76±5.29)mg/L]低于撤机成功组[(35.31±6.11)mg/L],差异均有统计学意义(均P<0.05)。多因素logistic回归方程分析显示CRP/ALB是撤机失败的独立预测因素(P<0.05)。ROC曲线分析显示CRP/ALB预测的AUC为0.887,灵敏度、特异度分别为85.26%和83.61%。结论CRP/ALB有助于预测机械通气治疗老年急性心力衰竭患者撤机结果。

Objective To evaluate the value of serum C-reactive protein to albumin(CRP/ALB)ratio for predicting weaning outcome in patients with acute heart failure(AHF)received mechanical ventilation.Methods 142 elderly patients with AHF who received mechanical ventilation from February 2017 to February 2019 in Yongkang First People's Hospital were enrolled.According to the outcomes of weaning,they were divided into weaning failure group(n=42)and weaning success group(n=100).The general clinical data included serum C-reactive protein(CRP)and albumin(ALB)were collected.CRP/ALB ratio was calculated.Logistic regression was used to analyze the factors related to weaning failure.The ROC curve was used to analyze the value of CRP/ALB ratio in predicting weaning outcome.Results Compared to weaning success group,the ratio of diabetes,creatinine and NT-proBNP were significantly higher,and hemoglobin,left ventricular ejection fraction and E/A were significantly lower in weaning failure group(all P<0.05).CRP[(14.76±5.56)mg/L]and CRP/ALB(0.45±0.15)were significantly higher and ALB[(32.76±5.29)mg/L]was significantly lower in weaning failure group than in weaning success group[(11.34±4.22)mg/L,(0.32±0.13)and(35.31±6.11)mg/L,respectively]before spontaneous breath test(all P<0.05).The multivariate logistic regression analysis showed that CRP/ALB was an independent predictor of weaning failure(P<0.05).ROC curve analysis showed that the area under curve of CRP/ALB was 0.887,and the sensitivity and specificity were 85.26%and 83.61%,respectively.Conclusion CRP/ALB may be helpful in predicting weaning outcomes in elderly AHF patients treated with mechanical ventilation.