白蛋白校正阴离子间隙对心脏骤停患者预后的预测价值

The predictive value of albumin-corrected anion gap in cardiac arrest patients

目的探讨白蛋白校正阴离子间隙(ACAG)对心脏骤停患者预后的预测价值。方法通过检索美国重症监护室(ICU)电子病例数据集MIMIC-Ⅲ收集2001年6月至2012年10月入住ICU的613例成年心脏骤停患者的临床资料。根据入院90 d患者生存情况分为存活组263例,死亡组350例;比较两组患者基本资料、入住ICU时实验室指标以及ICU入住时间、总住院时间等。绘制Kaplan-Meier生存曲线,比较高ACAG(>20 mmol/L)组与正常ACAG(12~20 mmol/L)组患者28、90 d累积生存率。采用Cox比例风险回归模型分析心脏骤停患者入院28、90 d死亡的独立危险因素。结果与存活组比较,死亡组患者年龄、ACAG、阴离子间隙等均明显较高(均P<0.05),而白蛋白、HCO3-、动脉血氧分压、血红蛋白以及合并冠心病、心肌梗死的比例均明显较低(均P<0.05),总住院时间明显缩短(P<0.05)。高ACAG组患者28、90 d累积生存率均明显低于正常ACAG组,差异均有统计学意义(均P<0.05)。入住ICU时高ACAG是心脏骤停患者入院28、90 d死亡的独立危险因素,其HR值及95%CI分别为1.388(1.074~1.795)和1.308(1.029~1.663)。结论入住ICU时高水平ACAG对心脏骤停患者预后具有一定的预测价值。

Objective To investigate the predictive value of albumin-corrected anion gap(ACAG)in patients with cardiac arrest(CA).Methods A total of 613 adult patients suffered from CA were collected by searching electronic case data sets for intensive care unit(ICU)in the United States MIMIC-Ⅲdatabase from June 2001 to October 2012,and the relevant clinical data were collected.According to the survival status of patients at 90 days after admission,patients were divided into two groups,two hundred and sixty-three cases in surviving group,three hundred and fifty cases in death group.The clinical baseline characteristics,laboratory indicators at ICU admission,ICU stay time and total length of hospital stay were compared between the two groups.The Kaplan-Meier survival curve was drawn to compare the 28-day and 90-day cumulative survival rates between the high ACAG(>20 mmol/L)group and normal ACAG(12-20 mmol/L)group.The Cox proportional-hazards regression model was then used to explore the independent risk factors for 28-day and 90-day mortality of patients with CA on admission.Results Compared with the survival group,the death group had significantly higher age,ACAG and anion gap(all P<0.05),while albumin,HCO3-,arterial oxygen pressure,hemoglobin,and the proportion of patients with coronary heart disease and myocardial infarction were significantly lower(all P<0.05),and the total hospital stay was significantly shorter(all P<0.05).Kaplan-Meier survival curves indicated that the 28-day and 90-day cumulative survival rate of CA patients of the high ACAG group was lower than those of the normal ACAG group(all P<0.05).The results of Cox regression models further showed that ACAG is independently associated with increased risk of 28-day(HR=1.388,95%CI:1.074-1.795)and 90-day(HR=1.308,95%CI:1.029-1.663)mortality for these patients.Conclusion High levels of ACAG at ICU admission has certain predictive value in predicting the prognosis of patients with CA.