脓毒症休克患者动脉血乳酸、血清白蛋白比值在预测病情评估及转归的临床价值

Clinical value of ratio of arterial lactic acid and serum albumin on predicting the severity evaluation and outcomes of patients with septic shock

目的 探究动脉血乳酸(LA)、血清白蛋白(ALB)比值预测脓毒症休克患者疾病危重程度及转归的价值。方法 选取2018年1月1日-2019年6月30日华西医院收治的脓毒症休克患者作为重症组,选择同期收治的脓毒症患者作为对照组,选择同期来医院体检的健康患者作为正常组,重症组、对照组均于入院时、入院6 h、24 h采血测定LA、ALB水平,正常组于入院时测定,计算LA/ALB比值,并根据序贯器官衰竭评分(SOFA)评分将重症组患者分为恶化组(22例)和转归组(97例),应用受试者工作特征曲线(ROC)评价上述指标预测脓毒症休克患者病情及转归的价值。结果 正常组入院时LA水平低于重症组、对照组(P<0.05);重症组不同时间点LA均高于对照组(P<0.05)。正常组入院时ALB水平高于重症组、对照组(P<0.05);重症组不同时间点ALB均低于对照组(P<0.05)。(3)重症组不同时间点LA/ALB比值均高于对照组(P<0.05)。转归组不同时间LA水平、LA/ALB比值低于恶化组,ALB水平高于恶化组(P<0.05)。ALB与SOFA评分呈负相关(P<0.05),LA及LA/ALB比值与SOFA评分呈正相关(P<0.05)。结论 脓毒症休克患者LA越高,ALB越低,LA/ALB比值越大,可能预后越差。

Objective To explore the value of ratio of arterial lactic acid(LA) and serum albumin(ALB) on predicting the disease severity and outcomes of patients with septic shock.Methods Patients with septic shock admitted between January 1,2018 and June 30,2019 were selected as severe group, and patients with sepsis treated during the same time period were included in control group, and healthy people who came to the hospital for physical examination during the same period were selected as normal group.Blood were collected in severe group and control group at admission and at 6 h and 24 h after admission to determine the levels of LA and ALB,and the levels in normal group were measured at admission and the ratio of LA/ALB was calculated.The patients in the severe group were classified as worsening group(22 cases) and outcome group(97 cases) according to the Sequential Organ Failure Assessment(SOFA) score.Receiver operating characteristic curve(ROC curve) was used to evaluate the value of the above indicators on predicting the disease severity and outcomes of patients with septic shock.Results(1)The LA level in normal group at admission was lower than that in severe group and control group(P<0.05).LA in severe group was higher than that in control group at different time points(P<0.05).(2)The ALB level at admission was higher in normal group than that in severe group and control group(P<0.05).ALB level was lower in severe group than that in control group at different time points(P<0.05).(3)The LA/ALB ratio in severe group at different time points was higher than that in control group(P<0.05).(4)The LA level and LA/ALB ratio of outcome group at different time points were lower than those of worsening group while the ALB level was higher than that of worsening group(P<0.05).(5)LA,ALB and LA/ALB ratio were the most effective in predicting the short-term prognosis of septic shock at 6 h after admission.LA/ALB ratio had the highest predictive efficiency, with sensitivity of 77.27% and specificity of 90.72%.(6)ALB was negatively correlated with SOFA score(P<0.05),and LA and LA/ALB ratio were positively correlated with SOFA score(P<0.05).Conclusion The higher LA,the lower ALB and the higher LA/ALB ratio may lead to worse prognosis in patients with septic shock.