LAR联合MHR对急性上消化道出血患者预后的预测价值

Predictive value of LAR plus MHR for prognosis of patients with acute upper gastrointestinal bleeding

目的 研究血清乳酸/白蛋白比值(LAR)、单核细胞/高密度脂蛋白胆固醇比值(MHR)早期动态升高对于急性上消化道出血患者预后的预测价值。方法 收集2019年1月至2021年10月北部战区总医院急诊医学科就诊的440例急性上消化道出血患者的临床资料。根据是否发生急性上消化道出血主要临床结局事件(因任何原因死亡,再次出现消化道出血,需要急诊外科手术和急诊介入手术)分为有主要临床结局事件组(n=91)和无主要临床结局事件组(n=349)。采用logistic回归分析影响患者出现主要临床结局的危险因素。采用受试者操作特征(ROC)曲线、净重新分类指数(NRI)、整体鉴别指数(IDI)、校准曲线分析LAR、MHR及两者联合对急性上消化道出血患者主要临床结局事件的预测效能。结果 Logistic回归分析结果显示,LAR、MHR升高,年龄增大,血红蛋白及红细胞压积减少等是急性上消化道出血患者出现主要临床结局的独立危险因素(均P <0.05)。相关性分析显示,HB与MHR呈负相关(r=-0.165,P <0.01),HB与LAR呈负相关(r=-0.247,P <0.01)。ALT (r=0.165)、PT (r=0.178)与LAR呈正相关(均P <0.01),PT与MHR呈正相关(r=0.142,P <0.01);ROC曲线分析结果显示LAR、MHR及二者联合预测患者不良结局的曲线下面积分别为:0.665 (95%CI:0.598~0.731)、0.863 (95%CI:0.821~0.905)、0.886 (95%CI:0.845~0.927),LAR、MHR最佳截断值分别为0.332、0.715。IDI、NRI及校准曲线结果显示,LAR联合MHR对急性上消化道出血是否出现主要临床结局的预测价值优于单独使用LAR及MHR;LAR联合MHR的灵敏度为84.6%,特异度为88.5%。结论 LAR、MHR早期动态升高对于预测急性上消化道患者主要临床结局事件具有较高的临床价值,且二者联合的预测价值优于LAR及MHR单独使用。

Objective To study the predictive value of serum lactate/albumin ratio(LAR)and monocyte/high-density lipoprotein cholesterol ratio(MHR)for the prognosis of patients with acute upper gastrointestinal bleeding.Methods Clinical data were collected from 440 patients with acute upper gastrointestinal bleeding treated at the Emergency Department of General Hospital Northern Theater Command from January 2019 to October 2021.According to whether the main clinical outcome event of acute upper gastrointestinal bleeding occurred(death for any reason,recurrence of gastrointestinal bleeding,requirement for emergency surgery,interventional surgery),patients were divided into the main clinical outcome event group(group A,n=91)and the no-main clinical outcome event group(group B,n=349).A logistic regression analysis analyzed the factors influencing the main clinical outcome events.Receiver operating characteristic(ROC)curves,integrated discrimination improvement(IDI),net reclassification index(NRI),and calibration curves were used to analyze the predictive efficacy of an early dynamic elevated LAR alone,MHR alone,and a combination thereof.Results The logistic regression analysis showed that elevated LAR and MHR,increased age,and reduced hemoglobin and hematocrit levels were independent risk factors for the occurrence of the main clinical outcomes(all P<0.05).A correlation analysis showed that hemoglobin level was negatively correlated with MHR and LAR(r=-0.165 and-0.247,all P<0.01).Alanine aminotransferase(ALT)and prothrombin time(PT)were positively correlated with LAR(r=0.165 and 0.178,all P<0.01).PT was positively correlated with MHR(r=0.142,P<0.01).The ROC curve analysis results showed that the area under the curve of LAR alone,MHR alone,and the combination thereof was 0.665(95%CI:0.598-0.731),0.863(95%CI:0.821-0.905),and 0.886(95%CI:0.845-0.927),while the cut-off values of LAR and MHR were 0.332 and 0.715,respectively.The IDI,NRI,and calibration curve results showed that the predictive value of LAR plus MHR for the occurrence of the main clinical outcome event was better than that of either alone. The sensitivity and specificity of LAR plus MHR were 84.6% and 88.5%,respectively. Conclusion Early dynamic elevation of LAR and MHR has high predictive value for the main clinical outcome events in patients with acute upper gastrointestinal bleeding,and the predictive value of LAR plus MHR is better than that of either alone.