血清白蛋白水平与心源性休克患者院内死亡风险的相关性研究

Correlation between serum albumin level and the risk of in-hospital mortality in patients with cardiogenic Shock

目的:研究证明低白蛋白血症与心血管疾病的发生、发展及密切相关,但目前关于血清白蛋白(Alb)水平与心源性休克(CS)的研究少,且缺乏具体线性关系的探讨,本研究目的是探索Alb对CS患者院内死亡风险的影响。方法:根据Alb四分位间距(Q)将CS患者分为4组,主要终点为院内死亡。建立多因素Logistic回归模型来评估Alb是否为院内死亡的危险因素,以Q4作为参照组。通过局部加权回归(Lowess)绘制出符合总体趋势的曲线。Alb与院内死亡风险调整混杂因素后的总体趋势通过限制性立方样条来描绘。结果:共1628例CS患者入选(Q4,n=422;Q3,n=473;Q2,n=342;Q1,n=391)。单因素Logistic回归模型中,随着Alb的下降,患者院内死亡的风险逐渐上升(Q1 vs.Q4:OR=2.07,95%CI:1.55~2.79,P<0.001,P趋势<0.001)。在模型3中,调整混杂因素后,Alb对院内死亡发生风险的影响被减弱,但是趋势没有变化,随着Alb上升,院内死亡的发生风险(Q1vs.Q4:OR=1.53,95%CI:1.11~2.12,P<0.001,P趋势<0.001)逐渐上升。Lowess平滑曲线表明,随着Alb下降,院内死亡风险明显升高,成线性关系。在限制性立方样条分析中,调整混杂因素后,结果与Lowess平滑曲线呈现的一致,随着Alb下降,院内死亡风险显著升高。结论:随着Alb下降,CS患者院内死亡风险显著升高,Alb是院内死亡的危险因素。

Objective:Studies have proved that hypoalbuminemia is closely related to the occurrence and development of cardiovascular diseases.However,few study was conducted to explore the relationship between serum albumin(Alb)level and cardiogenic shock(CS),and evidence for the linear relationship between both is lacking.The purpose of this study is to explore the impact of Alb on the risk of in-hospital mortality in patients with CS.Methods:Patients with CS were divided into 4 groups according to the interquartile range of Alb.The primary endpoint was in-hospital mortality.A multivariate Logistic regression model was established to evaluate the impact of Alb on the risk of in-hospital mortality,and independent risk factors were identified.Q4 was used as the reference group.Local weighted regression(Lowess)was used to draw a curve consistent with the overall trend.Overall trend after adjusting for confounders was drawn by restrictive cubic splines.Results:A total of 1628 CS patients were enrolled,grouped according to Alb interquartile range(Q4,n=422;Q3,n=473;Q2,n=342;Q1,n=391).In the univariate logistic regression model,with the decrease of Alb,the risk of in-hospital death gradually increased(Q1 vs.Q4:OR=2.07,95%CI:1.55-2.79,P<0.001,P for trend<0.001).In Model 3,after adjusting for confounders,the effect of Alb on the risk of in-hospital death was attenuated,but the trend did not change.As Alb increased,the risk of in-hospital death(Q1 vs.Q4:OR=1.53,95%CI:1.11-2.12,P<0.001,P for trend<0.001)gradually increased.The Lowess smooth curve showed that the risk of in-hospital mortality increased significantly as Alb decreased,in a linear relationship.In the restricted cubic spline analysis,after adjusting for confounders,the results were consistent with the Lowess smooth curve,with a significant increase in the risk of in-hospital mortality as Alb decreased.Conclusions:With the decrease of Alb,the risk of in-hospital mortality in CS patients increased significantly,and Alb was an independent risk factor for in-hospital mortality.