CAR联合心肺复苏持续时间对心脏骤停患者预后的预测价值

Prognostic value of CAR combined with CPR duration in patients with cardiac arrest

目的探讨C反应蛋白与白蛋白的比值(C-reactive protein to albumin ratio,CAR)及联合指标对心脏骤停(cardiac arrest,CA)患者预后的预测价值。方法回顾性分析2021年1月至2023年5月郑州大学第一附属医院收治的心肺复苏(cardiopulmonary resuscitation,CPR)后自主循环恢复患者,根据出院时存活状态分为存活组和死亡组,比较两组基线特征、心肺复苏抢救资料以及实验室指标。将有统计学意义的指标进行多因素Logistic回归分析,寻找影响CA患者预后的独立危险因素。绘制受试者工作特征曲线(ROC曲线),分析各独立影响因素及联合指标对CA患者预后的预测价值。结果共纳入145例患者,存活组33例,死亡组112例。患者CPR持续时间、升压药物使用剂量、ICU住院天数、入ICU时的急性生理与慢性健康评分Ⅱ、乳酸、纤维蛋白原、谷草转氨酶、白蛋白、降钙素原、C反应蛋白、CAR、肌红蛋白、肌酸激酶同工酶在存活组与死亡组间的差异有统计学意义(均P<0.05)。多因素Logistic回归分析显示,CAR、CPR持续时间是影响CA患者预后的独立危险因素(CAR:OR=2.372,95%CI:1.094~5.146,P=0.029;CPR持续时间:OR=1.170,95%CI:1.020~1.342,P=0.025)。ROC曲线分析显示,CAR、CPR持续时间及两者联合预测患者预后的曲线下面积分别是0.792、0.731、0.859,CAR与CPR持续时间的截断值分别是1.455、11.5 min。结论CAR、CPR持续时间为影响CA患者预后的独立危险因素,CAR、CPR持续时间联合检测的预测价值更高,当CAR>1.455、CPR持续时间>11.5 min时提示患者预后较差。

Objective Explore the predictive value of the C-reactive protein to albumin ratio(CAR)and combined indicators for the prognosis of cardiac arrest(CA)patients.Methods Retrospective analysis was conducted on patients who recovered spontaneous circulation after cardiopulmonary resuscitation(CPR)admitted to the First Affiliated Hospital of Zhengzhou University from January 2021 to May 2023.Patients were divided into survival and non-survival groups based on their status at discharge.Baseline characteristics,CPR data,and laboratory indicators were compared between the two groups.Statistically significant indicators were further analyzed using multivariate logistic regression to identify independent risk factors affecting the prognosis of CA patients.Receiver operating characteristic(ROC)curves were constructed to assess the predictive value of each independent factor and combined indicators for the prognosis of CA patients.Results A total of 145 patients were included in the study,including 33 patients in the survival group and 112 patients in the non-survival group.There were statistically significant differences between the survival group and the non-survival group in terms of CPR duration,the dosage of vasopressor drugs used,ICU length of stay,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score at ICU admission,lactate,fibrinogen,aspartate aminotransferase,albumin,procalcitonin,C-reactive protein,CAR,myoglobin,and creatine kinase isoenzyme(all P<0.05).Multivariate logistic regression analysis revealed that CAR and CPR duration were independent risk factors affecting the prognosis of CA patients(CAR:OR=2.372,95%CI:1.094~5.146,P=0.029;CPR duration:OR=1.170,95%CI:1.020~1.342,P=0.025).ROC curve analysis showed that the areas under the curve for CAR,CPR duration,and their combination in predicting patient prognosis were 0.792,0.731,and 0.859,respectively.The cut-off values for CAR and CPR duration were 1.455 and 11.5 minutes,respectively.Conclusions The CAR and CPR duration are independent risk factors affecting the prognosis of CA patients,and the predictive value is higher when both CAR and CPR duration are combined.A CAR greater than 1.455 and a CPR duration longer than 11.5 minutes suggest a poorer prognosis for the patients.