血尿素氮与白蛋白比值在心源性休克患者住院期间预后中的关系研究

Correlation between the blood urea nitrogen to albumin ratio and the prognosis of patients with cardiogenic shock during hospitalization

目的探讨血尿素氮与白蛋白比值(B/A)与心源性休克(CS)患者住院期间预后的关系。方法利用第四代重症医学监护信息数据库1.0版本检索2008至2019年首次入住重症监护室(ICU)治疗且年龄≥18岁的884例CS患者为研究对象,根据住院期间(30 d内)预后情况分为存活组575例、死亡组309例;比较两组患者临床资料,采用多因素Cox风险回归模型分析CS患者住院期间预后的影响因素。结果与存活组比较,死亡组患者年龄、序贯器官衰竭评估(SOFA)评分、血尿素氮、B/A、血乳酸、血肌酐以及合并慢性肾脏病、心脏骤停、急性肾损伤的比例均较高,白蛋白、血红蛋白水平均较低,总住院时间较短,差异均有统计学意义(均P<0.05)。年龄(HR=1.022)、SOFA评分(HR=1.063)、B/A(HR=1.492)、血乳酸(HR=1.059)、合并心脏骤停(HR=1.626)、合并急性肾损伤(HR=1.553)是CS患者住院期间预后的独立影响因素(均P<0.05)。结论CS患者入住ICU时B/A升高是住院期间(30 d内)死亡的独立影响因素,临床上应引起重视,建议结合患者年龄、SOFA评分、血乳酸以及合并心脏骤停、急性肾损伤情况综合评估患者预后。

Objective To explore the relationship between the blood urea nitrogen to albumin ratio(B/A)and the prognosis of patients with cardiogenic shock(CS)during hospitalization.Methods The medical information mart for intensive careⅣversion 1.0 was used,we retrieved 884 cases of patients with CS who were firstly admitted to the intensive care unit(ICU)from 2008 to 2019 for treatment and aged≥18 years as study subjects,and they were divided into 575 cases in the survival group and 309 cases in the death group according to the prognosis during the hospitalization period(within 30 d).The clinical data of patients in the two groups were compared,and the multifactorial Cox regression model was used to analyze the influencing factors on the prognosis of the CS patients during hospitalization.Results Compared to the survival group,patients in the death group had higher age,sequential organ failure assessment(SOFA)score,blood urea nitrogen,B/A ratio,blood lactate,blood creatinine,and a higher proportion of comorbidities such as chronic kidney disease,cardiac arrest,and acute kidney injury,and lower levels of albumin and hemoglobin,and a shorter total length of hospital stay.All differences were statistically significant(all P<0.05).Age(HR=1.022),SOFA score(HR=1.063),B/A(HR=1.492),blood lactate(HR=1.059),combined cardiac arrest(HR=1.626),and comorbid acute kidney injury(HR=1.553)were the independent influencing factors for the prognosis of the CS patients during their hospitalization(all P<0.05).Conclusion Elevated B/A ratio in CS patients upon ICU admission is an independent influencing factor for mortality during hospitalization(within 30 d),which should be taken more seriously clinically.It is recommended that the prognosis of patients should be assessed in combination with their age,SOFA scores,blood lactate levels,as well as the presence of comorbid cardiac arrest and acute kidney injury.