血清ALB水平与老年社区获得性肺炎β-内酰胺类抗菌药物治疗无效风险的相关性、预测阈值及其效能

Association of serum albumin level with risk of treatment failure withβ-lactam antibiotics for elderly com⁃munity-acquired pneumonia and the predictive threshold and efficacy

目的分析患者入院时血清白蛋白(ALB)水平与老年社区获得性肺炎(CAP)β-内酰胺类抗菌药物治疗无效风险的相关性,观察其预测阈值、预测效能。方法老年CAP患者86例,采集患者入院当天的血清测定血清ALB,按四分位数分组,分别为Q1组、Q2组、Q3组和Q4组。患者均接受β-内酰胺类抗菌药物治疗,观察各组患者疗效,计算治疗显效率。收集CAP患者的人口学信息,包括年龄、性别、合并症、实验室指标、临床病情严重程度指标(CURB-65评分),采用单因素logistic回归模型分析老年CAP患者血清ALB水平与β-内酰胺类抗菌药物治疗无效风险的相关性。以单因素分析结果中有统计学差异的变量并加入年龄、性别作为混杂因素,采用多变量logistic回归模型分析老年CAP患者血清ALB水平与β-内酰胺类抗菌药物治疗无效风险的相关性。采用限制性立方样条(RCS)模型分析老年CAP患者血清ALB水平与β-内酰胺类抗菌药物治疗无效风险之间的关系,评估β-内酰胺类抗菌药物治疗无效风险的阈值。以阈值为分组依据,采用分层多因素logistic回归分析法,分析老年CAP患者血清ALB水平与β-内酰胺类抗菌药物治疗无效风险的关系。结果86例CAP患者的血清ALB水平为(29.0±5.1)g/L,59例治疗显效,27例治疗无效,Q1组、Q2组、Q3组、Q4组治疗显效率分别为39.13%、76.19%、71.43%、91.48%。Q1组患者有慢性阻塞性肺疾病(COPD)病史者比例低于其他各组(P<0.05),Q4组患者中性粒细胞(NC)和C反应蛋白(CRP)水平低于其他各组(P均<0.05)。老年CAP患者血清ALB水平与β-内酰胺类抗菌药物治疗无效风险负相关[Q2组OR(95%CI)为0.18(0.04~0.78),Q3组OR(95%CI)为0.19(0.04~0.93),Q4组OR(95%CI)为0.07(0.01~0.46),P for trend=0.019]。老年CAP患者血清ALB水平与β-内酰胺类抗菌药物治疗无效风险间呈现明显的L形非线性关系,老年CAP患者接受β-内酰胺类抗菌药物治疗无效风险的血清ALB水平阈值为30 g/L。老年CAP患者血清ALB水平≤30 g/L时,血清ALB水平每增高1倍标准差(Per-SD),β-内酰胺类抗菌药物治疗无效的风险降低82%[OR(95%CI)为0.18(0.04~0.58),P<0.05];老年CAP患者血清ALB水平>30 g/L,血清ALB水平与β-内酰胺类抗菌药物治疗无效风险间无显著关联(P>0.05)。结论老年CAP患者血清ALB水平与β-内酰胺类抗菌药物治疗无效风险呈负相关关系。老年CAP患者接受β-内酰胺类抗菌药物治疗无效风险的血清ALB水平阈值为30 g/L,当老年CAP患者血清ALB水平≤30 g/L时,β-内酰胺类抗菌药物治疗无效的风险较高。

Objective To investigate the relationships between serum albumin(ALB)levels and the risk of treat⁃ment failure withβ-lactam antibiotics in elderly patients with community-acquired pneumonia(CAP)as well as the predic⁃tive threshold and efficacy.Methods According to serum ALB levels on the day of admission,86 elderly patients with CAP were divided by quartiles into Q1 group,Q2 group,Q3 group,and Q4 group.All the patients receivedβ-lactam anti⁃biotics,and the treatment response rate was compared between groups.The data on age,sex,comorbidities,laboratory in⁃dicators,and the CURB-65 severity score were collected.To analyze the association of serum ALB levels with the risk ofβ-lactam antibiotic failure,we performed univariable Logistic regression analyses to select significant variables,and then in⁃cluded them along with age and sex as confounding factors in a multivariable Logistic regression model for further analysis.We constructed a restricted cubic spline(RCS)model to determine the serum ALB threshold for the risk of non-response toβ-lactam antibiotics.Using the threshold as the grouping criterion,a stratified multivariable Logistic regression analysis was conducted to analyze the relationships between serum ALB levels and the risk ofβ-lactam antibiotic failure.Results The serum ALB level of the 86 patients with CAP was(29.0±5.1)g/L.Fifty-nine patients responded toβ-lactam antibiot⁃ics,while the remaining 27 patients did not.The response rates in the Q1,Q2,Q3,and Q4 groups were 39.13%,76.19%,71.43%,and 91.48%,respectively.The proportion of patients with a history of chronic obstructive pulmonary disease in the Q1 group was significantly lower than those in the other groups(all P<0.05).The Q4 group showed a signifi⁃cantly lower neutrophil count and a significantly lower C-reactive protein level than the other groups(all P<0.05).Serum ALB level was negatively associated with the risk ofβ-lactam antibiotic failure in the elderly patients with CAP:the odds ratio(OR)and 95%confidence interval(CI)were 0.18(0.04-0.78)in the Q2 group,0.19(0.04-0.93)in the Q3 group,and 0.07(0.01-0.46)in the Q4 group(P for trend=0.019).The RCS analysis showed an L-shaped non-linear re⁃lationship between serum ALB level and the risk of non-response toβ-lactam antibiotics,and the serum ALB threshold as⁃sociated with the risk of treatment failure was 30 g/L.When serum ALB levels were≤30 g/L,the risk of non-response per standard deviation increase in ALB decreased by 82%(OR=0.18,95%CI:0.04-0.58,P<0.05);when serum ALB lev⁃els were>30 g/L,there was no significant relationship between serum ALB level and the risk ofβ-lactam antibiotic failure(P>0.05).Conclusions Serum ALB level is negatively correlated with the risk ofβ-lactam antibiotic failure in elderly patients with CAP.The serum ALB threshold for the risk of non-response toβ-lactam antibiotics in elderly CAP patients is 30 g/L,and there is a higher risk ofβ-lactam antibiotic failure for elderly CAP patients with the serum ALB level within 30 g/L.