心源性休克患者住院期间死亡风险与ACAG的关系

Association between risk of death during hospitalization and ACAG in patients with cardiogenic shock

目的 探讨白蛋白校正阴离子间隙(albumin corrected anion gap,ACAG)值的高低与心源性休克(cardiogenic shock,CS)患者预后的关系。方法 回顾性分析2001年6月至2012年10月美国重症监护数据库Ⅲ(Medical Information Mart for Intensive CareⅢ,MIMIC-Ⅲ)中在重症监护室(intensive care unit,ICU)住院的成人CS患者528例。根据住院期间(≤30d)预后情况将其分为存活组(n=316)和死亡组(n=212),比较两组性别、年龄、住院期间临床结局等临床资料。根据ACAG水平将患者分为正常ACAG组(12~20mmol/L,n=289)和高ACAG组(>20mmol/L,n=239),采用Kaplan-Meier生存曲线和log-rank检验评价生存风险,采用Cox比例风险回归模型评价危险因素。结果 与存活组相比,死亡组的年龄、序贯器官衰竭评分(sequential organ failure assessment,SOFA评分)、阴离子间隙(anion gap,AG)、红细胞分布宽度(red blood cell distribution width,RDW)、肌酐、国际标准化比值(international normalized ratio,INR)更高,白蛋白值更低,合并心脏骤停及慢性阻塞性肺疾病者更多,ACAG值更高,总体住院时间更短(P<0.05)。Kaplan-Meier生存曲线结果显示,高ACAG组CS患者30d累积生存率显著低于正常ACAG组(log-rank χ2=15.120,P<0.05)。多因素Cox比例风险回归分析结果表明高ACAG是影响ICU的CS患者住院期间全因死亡率的独立危险因素[(风险比(hazard ratio,HR)=1.444,95%置信区间(confidence interval,CI):1.077~1.935,P<0.05]。结论 ICU住院患者中,ACAG增高是CS患者住院期间(≤30d)全因死亡率的独立危险因素,在临床工作可利用其早期预警作用帮助临床医生进行适时干预,从而达到降低CS患者死亡率的目的。

Objective To investigate the relationship between high and low albumin corrected anion gap(ACAG)values and the prognosis of patients with cardiogenic shock(CS).Methods A total of 528 adult CS patients hospitalized in intensive care unit(ICU)from June 2001 to October 2012 in the Medical Information Mart for Intensive CareⅢ(MIMIC-Ⅲ)database in the United States were retrospectively analyzed.They were divided into the survival group(n=316)and death group(n=212)according to the survival outcome during hospitalization(≤30 days),and the clinical data such as gender and age were compared between the two groups.According to the ACAG level,patients were divided into normal ACAG group(12-20 mmol/L,n=289)and high ACAG group(>20 mmol/L,n=239),and the survival risk was evaluated using Kaplan-Meier survival curve and log-rank test,and the risk factors were evaluated using Cox proportional risk regression model.Results Compared to the survival group,the death group had higher age,sequential organ failure score,anion gap(AG),red blood cell distribution width(RDW),creatinine,international normalised ratio(INR)were higher,albumin values were lower,there were more combined cardiac arrests and chronic obstructive pulmonary disease,ACAG values were higher,and overall hospital stay was shorter(P<0.05).The results of Kaplan-Meier survival curves showed that the 30 days cumulative survival rate of CS patients in the high ACAG group was significantly lower than that in the normal ACAG group(log-rankχ2=15.120,P<0.05).The results of multifactorial Cox proportional risk regression analysis showed that high ACAG was an independent risk factor affecting all-cause mortality during hospitalization in CS patients in the ICU[(hazard ratio(HR)=1.444,95%confidence interval(CI):1.077-1.935,P<0.05].Conclusions Increased ACAG is an independent risk factor for all-cause mortality during hospitalisation(≤30 days)in patients admitted to ICUs, and its early warning role can be used in clinical work to help clinicians make timely interventions to reducemortality in CS patients.