缺血修饰白蛋白对急性主动脉夹层患者院内死亡的预测价值

The value of ischemia modified albumin level for predicting in-hospital mortality in patients with acute aortic dissection

目的探讨缺血修饰白蛋白(IMA)对急性主动脉夹层(AAD)患者院内死亡的预测价值。方法连续收集2017年1月至2019年11月因AAD在川北医学院附属医院心脏大血管外科救治的195例患者的临床资料,其中男126例,女69例;按照患者住院期间是否死亡分为生存组和死亡组,分别记录两组患者的基本资料及入院时IMA水平;将单因素分析具有统计学意义的变量进行多因素logistic回归分析,采用受试者工作特征(ROC)曲线计算ROC曲线下面积(AUC),以评估IMA对AAD患者住院期间全因死亡的预测价值。结果本组AAD患者院内全因死亡42例,存活153例,死亡率为21.5%;多因素logistic回归分析结果显示:年龄(OR=2.143,95%CI:1.247~4.826,P=0.011)、Stanford A型(OR=6.751,95%CI:3.189~14.291,P<0.001)、药物治疗(OR=5.133,95%CI:2.463~10.700,P<0.001)及IMA水平(OR=4.452,95%CI:2.231~8.953,P=0.004)是AAD患者院内死亡的独立危险因素,手术是AAD患者院内死亡的保护性因素(OR=0.195,95%CI:0.093~0.406,P<0.001)。IMA预测AAD患者院内死亡的AUC为0.838(95%CI:0.774~0.901,P<0.001),最佳截断值为86.55 U/ml,灵敏度为83.3%,特异度为75.2%。结论IMA可对AAD患者进行危险评估,入院时IMA水平是AAD患者院内死亡的独立危险因素;对于IMA水平较高者,应及早进行手术干预。

Objective To investigate the value of ischemia modified albumin(IMA)level for predicting in-hospital mortality in patients with acute aortic dissection(AAD).Methods A total of 195 patients with AAD from the Department of Cardio-Vascular Surgery of Affiliated Hospital of North Sichuan Medical College from January 2017 to November 2019 were consecutively collected,with 126 males and 69 females.Based on whether they died during hospitalization or not,these patients were divided into 2 groups:survival group and mortality group.The baseline data and IMA levels at admission of the two groups were recorded.Univariate logistic regression analysis was used to identify the independent risk factors,and multivariate logistic regression analysis was further performed on variables with statistical significance in univariate analysis.The area under the receiver operating characteristic(ROC)curve was calculated to determine the value of IMA for predicting in-hospital mortality in patients with AAD.Results Forty-two AAD patients died and 153 survived,and the mortality rate was 21.5%.Logistic regression analysis showed that age(OR=2.143,95%CI:1.247-4.826,P=0.011),Stanford type A(OR=6.751,95%CI:3.189-14.291,P<0.001),drug therapy(OR=5.133,95%CI:2.463-10.700,P<0.001),IMA level(OR=4.452,95%CI:2.231-8.953,P=0.004)were independent risk factors for in-hospital mortality in patients with AAD,however surgery was a protective factor(OR=0.195,95%CI:0.093-0.406,P<0.001).The area under the ROC curve for IMA level in predicting in-hospital mortality with AAD was 0.838(95%CI:0.774-0.901,P<0.001),with a cut-off value of 86.55 U/ml,and the sensitivity and specificity were 83.3%and 75.2%,respectively.Conclusions IMA may serve as a simple risk assessment indicator for patients with AAD.IMA level at admission is an independent predictor of in-hospital mortality.For patients with higher IMA level,early surgical intervention should be performed.