血尿素氮与白蛋白比值与脓毒症合并急性呼吸衰竭患者死亡的相关性分析

Correlation analysis of blood urea nitrogen to albumin ratio and mortality in sepsis patients with acute respiratory failure

目的探讨血尿素氮与白蛋白比值(blood urea nitrogen to albumin ratio,B/A)与脓毒症合并急性呼吸衰竭(acute respiratory failure,ARF)患者住院期间死亡的相关性。方法回顾性分析美国重症医学数据库Ⅳ中2008~2019年重症监护病房(intensive care unit,ICU)的脓毒症合并ARF患者3806例的临床资料,根据住院30d内结局将其分为存活组(n=2677)和死亡组(n=1129)。使用Kaplan-Meier法和Log-rank检验评价生存风险,Cox比例风险回归分析探讨脓毒症合并ARF患者住院期间死亡的危险因素。结果死亡组患者的年龄显著大于存活组,序贯器官衰竭评估评分、血尿素氮、B/A、阴离子间隙、白细胞、血肌酐及连续性肾脏替代治疗、机械通气、合并慢性肾脏病、急性肾损伤、心脏骤停和急性心肌梗死的比例均显著高于存活组,白蛋白、红细胞、血小板均显著低于存活组,总住院时间显著短于存活组(P<0.05)。生存曲线显示,随着B/A的上升,患者住院期间累积生存率逐渐降低(χ^(2)=82.700,P<0.001)。多因素Cox回归分析显示,B/A>4.34是脓毒症合并ARF患者住院期间死亡的独立危险因素(HR=1.450,95%CI 1.208~1.742,P<0.001)。结论入住ICU时B/A>4.34是脓毒症合并ARF患者住院期间死亡的独立危险因素,早期识别并及时干预有助于降低脓毒症合并ARF患者的死亡风险。

Objective To investigate the correlation between blood urea nitrogen to albumin ratio(B/A)and in-hospital death in patients with acute respiratory failure(ARF)caused by sepsis.Methods The clinical data of 3806 patients with sepsis complicated with ARF admitted to intensive care unit(ICU)from 2008 to 2019 in the United States Medical Information Mart for Intensive CareⅣwere retrospectively analyzed.According to the outcome within 30 days of hospitalization,they were divided into survival group(n=2677)and death group(n=1129).Kaplan-Meier test and Log-rank test were used to evaluate the survival risk.Cox proportional risk regression analysis was used to investigate the risk factors of in-hospital death in patients with sepsis and ARF.Results Patients in death group were significantly older than those in survival group,sequential organ failure assessment score,blood urea nitrogen,B/A,anion gap,leukocyte,serum creatinine and the rates of continuous renal replacement therapy,mechanical ventilation,combined chronic kidney disease,acute kidney injury,cardiac arrest and acute myocardial infarction were significantly higher than those in survival group,albumin,erythrocyte and platelet were significantly lower than those in survival group,and the total hospital stay was significantly shorter than that in survival group(P<0.05).The survival curve showed that with the increase of B/A,the cumulative survival rate decreased gradually during hospitalization(χ^(2)=82.700,P<0.001).Multivariate Cox regression analysis showed that B/A>4.34 was an independent risk factor for in-hospital death in patients with sepsis and ARF(HR=1.450,95%CI 1.208~1.742,P<0.001).Conclusion B/A>4.34 at ICU admission is an independent risk factor for death during hospitalization in patients with sepsis and ARF.Early identification and timely intervention can help reduce the risk of death in patients with sepsis and ARF.