糖化血红蛋白预测流感肺炎患者死亡风险

Glycated haemoglobin A1c predicts the mortality risk in patients with infl uenza pneumonia

目的研究糖化血红蛋白(glycated haemoglobin A1c,HbA1c)是否可以作为预测流感肺炎患者死亡风险的指标。方法本研究为单中心回顾性研究,纳入2017年至2019年首都医科大学附属北京朝阳医院急诊留观或住院部的流感肺炎患者。收集性别、年龄、基础疾病、流感病毒核酸或抗原结果、胸片或胸CT报告、血常规结果、生化指标、HbA1c和降钙素原(procalcitonin,PCT)等信息,依据28 d死亡分为生存组和死亡组。比较两组之间的差异,并采用Cox回归分析28 d死亡的危险因素。结果本研究纳入研究对象122例,分为生存组94(77.0%)例和死亡组28(23.0%)例。单因素分析发现,与生存组相比,死亡患者淋巴细胞计数[0.49(0.33,0.73)vs.0.77(0.49,1.23)×10^(9)/L,Z=-3.008,P=0.003]降低,HbA1c水平[6.5(6.1,7.1)vs.6.1(5.7,6.8)%,Z=2.203,P=0.028]和PCT水平[0.64(0.20,6.43)vs.0.16(0.05,0.87)μg/L,Z=2.594,P=0.009]升高。Cox多因素回归和生存分析发现,校正年龄后,淋巴细胞计数(HR=0.260,95%CI:0.087~0.773,P=0.015)和HbA1c(HR=1.295,95%CI:1.007~1.666,P=0.044)是28 d死亡的独立危险因素。结论HbA1c可作为预测流感肺炎患者28 d死亡的独立危险因素。

Objective To investigate whether glycated haemoglobin A1c(HbA1c)can be used as a predictor of mortality risk in patients with infl uenza pneumonia.Methods This study was a singlecenter retrospective study,and enrolled patients with infl uenza pneumonia in the Emergency Department and in-patient departments of Beijing Chaoyang Hospital,Capital Medical University from 2017 to 2019.Gender,age,underlying diseases,infl uenza virus nucleic acid or antigen results,chest X-ray or chest CT reports,routine blood test,biochemical indicators,HbA1c and procalcitonin(PCT)were collected,and all subjects were divided into survival and death groups based on 28-day mortality.The differences between the two groups were compared and Cox regression was used to analyze risk factors for 28-day mortality.Results In this study,122 patients with infl uenza pneumonia were included,and 94(77.0%)cases were divided into the survival group and 28(23.0%)cases into the death group.Univariate analysis showed that lymphocyte counts[0.49(0.33,0.73)vs.0.77(0.49,1.23)×10^(9)/L,Z=-3.008,P=0.003]were lower and HbA1c levels[6.5(6.1,7.1)vs.6.1(5.7,6.8)%,Z=2.203,P=0.028]and PCT levels[0.64(0.20,6.43)vs.0.16(0.05,0.87)μg/L,Z=2.594,P=0.009]were higher in dead patients compared with those in the survivors.Cox multivariate regression and survival analysis found that after adjusting for age,lymphocyte counts(HR=0.260,95%CI:0.087-0.773,P=0.015)and HbA1c levels(HR=1.295,95%CI:1.007-1.666,P=0.044)were independent risk factors for 28-day mortality.Conclusions HbA1c is an independent risk factor for predicting 28-day mortality in patients with infl uenza pneumonia.