乳酸脱氢酶与白蛋白比值对脓毒症相关急性肾损伤患者短期预后的影响

Effect of lactate dehydrogenase to albumin ratio on the short⁃term prognosis in patients with sepsis⁃associ⁃ated acute kidney injury

目的探讨乳酸脱氢酶与血清白蛋白比值与脓毒症相关急性肾损伤患者的短期预后之间的关系。方法回顾性分析2018年1月至2022年6月在首都医科大学附属北京世纪坛医院重症医学科治疗的463例脓毒症患者。将患者分为两组:伴有继发性急性肾损伤组(sepsis patients with secondary acute kidney injury,AKI)和无急性肾损伤组(sepsis patients without secondary acute kidney injury,Non-AKI)。对比两组患者的急性生理学和慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、血清肌酐(serum creatinine,SCr)、乳酸脱氢酶(lactate dehydrogenase,LDH)和白蛋白(albumin,ALB)等指标。采用多因素logistic回归分析确定脓毒症相关急性肾损伤预后的危险因素,以及通过ROC分析评估APACHEⅡ评分、SOFA评分、PCT、SCr、乳酸脱氢酶与白蛋白比值(lactatedehy-drogenase/albuminratio,LAR)对预测脓毒症相关急性肾损伤短期预后的价值。结果Non-AKI组ICU 28 d病死率低于AKI组(24.68%vs.35.76%,P<0.05),Non-AKI组重症监护病房(intensive care unit,ICU)住院时间短于AKI组[(8.36±2.47)d vs.(9.15±3.89)d,P<0.05]。APACHEⅡ评分、SOFA评分、PCT、SCr、LAR为脓毒症相关急性肾损伤患者28 d死亡的独立影响因素(P<0.05)。ROC曲线显示,LAR水平对脓毒症相关急性肾损伤患者短期预后的预测价值高于APACHEⅡ评分、SOFA评分、PCT、SCr(AUC 0.819、0.762、0.655、0.615、0.803)。结论LAR是脓毒症相关AKI的独立危险因素,并且与患者的28 d病死率相关。

Objective To explore the relationship between lactate dehydrogenase to albumin ratio(LAR)and short-term prognosis in patients with sepsis-associated acute kidney injury(AKI).Methods A retrospective analysis was conducted on 463 sepsis patients treated in the intensive care unit(ICU)of Beijing Shijitan Hospital,Capital Medical University,from January 2018 to June 2022.The patients were divided into two groups:a group with secondary AKI(AKI group)and the one without acute kidney injury(non-AKI group).Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ),Sequential Organ Failure Assessment(SOFA),and levels of procalcitonin(PCT),C-reactive protein(CRP),serum creatinine(SCr),lactate dehydrogenase(LDH),and albumin(ALB)were compared between the two groups.Multivariate logistic regression analysis was used to determine prognostic factors for sepsis-associated acute kidney injury,and Receiver Operating Characteristic(ROC)analysis was performed to assess the predictive value of APACHEⅡscore,SOFA score,PCT,SCr,and lactate dehydrogenase to albumin ratio(LAR)for short-term prognosis of sepsis-associated acute kidney injury.Results The 28-day mortality rate in the non-AKI group was lower than that in the AKI group,and the length of stay in ICU was shorter in the non-AKI group than in the AKI group(P<0.05).APACHEⅡscore,SOFA score,PCT,SCr and LAR were independent influencing factors for 28-days death in patients with sepsis-associated acute kidney injury.The ROC curve analysis showed that LAR level had a higher predictive value for short-term prognosis in patients with sepsis-associated AKI as compared with APACHEⅡscore,SOFA score,PCT,and SCr.Conclusions LAR is an independent risk factor for sepsis-associated AKI and is associated with 28-day mortality in patients.