联合使用血尿素氮和sPESI评估急性重症肺栓塞病人的30天死亡风险

Blood Urea Nitrogen with Simplified Pulmonary Embolism Severity Index Helps Evaluate 30-day Mortality of Patients with Acute Pulmonary Embolism Admitted to Intensive Care Unit

【目的】探究血尿素氮(BUN)是否有助于增强简化版肺栓塞严重指数(sPESI)的危险分层能力。【方法】本回顾性研究纳入了在MIMICⅢ数据库中被诊断为急性重症肺栓塞的患者,并将他们在30 d内的死亡率作为此次研究的主要结局。根据ROC曲线的最大Youden指数计算BUN和sPESI的最佳截断值;使用Kaplan-Meier曲线评价BUN、sPESI及其组合在总队列和亚组中的危险分层能力。【结果】本研究共纳入了250名急性重症肺栓塞患者。BUN和sPESI均为30 d死亡率的独立预测指标。BUN的最佳截断值为21.5 mg/dL,sPESI的最佳截断值为2.5。在BUN≥21.5mg/dL和sPESI≥3的高风险组别中,患者30 d的死亡率为41.38%,明显高于sPESI≥1的组别(死亡率为14.28%)。在BUN≤21.5mg/dL和sPESI≤2的低风险组别中,死亡率为4.07%,和sPESI=0定义的低危组相近(死亡率为3.85%)。【结论】联合使用BUN和sPESI可以筛选出病情更为严重的急性重症肺栓塞患者,有助于临床治疗方案的确定。

【Objective】Whether blood urea nitrogen(BUN)can help increase risk stratification of simplified pulmonary embolism severity index(sPESI)in intensive care unit(ICU)still remains unknown.【Methods】A total of 250 patients diagnosed as acute pulmonary embolism(APE)at ICU admission from medical information mart for intensive careⅢ database(MIMIC)were included in this retrospective study. The 30-day mortality was defined as the primary outcome.The optimal cut-off values of BUN and sPESI were calculated based on the maximum Youden index of receiver operating characteristic(ROC)curves. The Kaplan-Meier curves were used to evaluate the risk stratification ability of BUN,sPESI,and their combinations in the total cohort and subgroups.【Results】BUN and sPESI were both independent predictors for the 30-day mortality. The optimal cut-off value of BUN was 21.5 mg/dL and that of sPESI was 2.5. The 30-day mortality was 41.38% in high-risk group with BUN ≥21.5 mg/dL and sPESI ≥3,which was higher than that in group with sPESI ≥1(14.28%). And it was 4.07% in low-risk group with BUN ≤21.5 mg/dL and sPESI ≤2,which was near that of the group with sPESI =0(3.85%).【Conclusions】BUN can help define a higher risk group with sPESI in APE admitted to ICU,which can contribute to the clinical management.