白蛋白与血红蛋白/白蛋白评估创伤失血性休克患者预后的临床研究

Albumin and hemoglobin to albumin ratio in evaluating the prognosis of patients with traumatic hemorrhagic shock

目的探究白蛋白(ALB)和血红蛋白/白蛋白(HB/ALB)对创伤失血性休克(THS)患者预后的预测价值。方法回顾性分析2020年1月—2021年12月南京医科大学第一附属医院行创伤绿色通道的90例THS患者数据,根据7 d内是否死亡分为生存组(n=76)与死亡组(n=14)。比较两组人口学资料、院前时间、GCS、生命体征、ISS、入院首次实验室结果、入院24 h内的补液输血情况、结局指标。受试者工作特征(ROC)曲线下面积确定各预测指标的截断值,单因素与多因素Logistic回归分析预测7 d死亡的独立危险因素,并根据HB/ALB的截断值分组,绘制生存曲线,评估与各次要结局指标之间的关系。结果90例THS患者中,男性62例,女性28例;年龄18~84岁,平均46.9岁;7 d内死亡14例(15.6%)。死亡组与生存组之间年龄[(56.8±16.6)岁vs.(45.0±18.3)岁]、GCS(12分vs.15分)、ISS(29分vs.19分)、尿素氮[(8.0±2.6)mmol/L vs.(5.6±2.0)mmol/L]、肌酐(100.8 mol/L vs.61.3 mol/L)、ALB[(23.2±4.0)g/L vs.(30.2±6.6)g/L]、PT(15.7 s vs.13.6 s)、APTT(34.9 s vs.28.3 s)比较差异有统计学意义(P<0.05)。多因素回归分析发现ALB≤28.1 g/L(OR=112.791,95%CI:1.663~7647.721,P=0.028)、GCS≤13分(OR=18.293,95%CI:1.037~322.820,P=0.047)是7 d死亡的独立危险因素。通过绘制7 d生存曲线发现HB/ALB>3.3患者的病死率明显高于HB/ALB≤3.3患者,同时发生多器官功能障碍综合征、使用机械通气以及入住重症监护室的概率明显升高。结论早期ALB水平能预测THS患者的预后情况,ALB≤28.1 g/L提示THS患者预后不佳。HB/ALB>3.3对THS患者的多器官功能障碍综合征、使用机械通气以及入住ICU等次要预后也有不良影响,动态监测ALB与HB/ALB对于评估复苏情况、指导复苏有一定意义。

Objective To investigate the predictive value of albumin(ALB)and hemoglobin to albumin ratio(HB/ALB)on the prognosis of patients with traumatic hemorrhagic shock(THS).Methods Data of 90 THS patients by green channel of the First Affiliated Hospital of Nanjing Medical University from Jan.2020 to Dec.2021 were retrospectively analyzed.Based on the 7-day outcome,patients were classified into survival group(n=76)and death group(n=14).Demographics,prehospital time,Glasgow coma scale/score(GCS),vital signs,ISS,first laboratory results on admission,fluid and blood transfusion within 24 h of admission,and secondary outcomes(incidence of multiple organ failure(MOF),use of mechanical ventilation,admission to ICU,etc.)were compared between the two groups.The area undeRthe receiveRoperating characteristic curve was used to determine the cut-off value foReach significant predictoRof 7-day mortality,and univariate and multivariate logistic regression analyses were furtheRadopted to explore the risk predictors.The Kaplan-MeieRsurvival curves were drawn according to the cut-off of HB/ALB,and the relationship between HB/ALB and each secondary outcome was evaluated.Results Among the 90 THS patients,62 were male and 28 were female,with a mean age of 46.9 years.At 7 days,14 patients(15.6%)died and enrolled in the death group.Comparison between the 7-day death group and the survival group showed significant differences in terms of age(years,56.8±16.6 vs.45.0±18.3),GCS(12 vs.15),ISS(29 vs.19),urea nitrogen(mmol/L,8.0±2.6 vs.5.6±2.0),creatinine(mol/L,100.8 vs.61.3),ALB(g/L,23.2±4.0 vs.30.2±6.6),prothrombin time(s,15.7 vs.13.6),and activated partial thromboplastin time(s,34.9 vs.28.3).Multivariate logistic regression revealed that ALB≤28.1 g/L(OR=112.791,95%CI:1.663-7647.721,P=0.028)and GCS≤13(OR=18.293,95%CI:1.037-322.82,P=0.047)were independent risk factors foR7-day mortality of THS patients.The Kaplan-MeieR7-day survival curve showed that HB/ALB>3.3 was associated with a much higheR7-day mortality(χ2=9.096,P=0.003),togetheRwith higheRincidences of MOF,mechanical ventilation,and admission to ICU.Conclusion Early ALB level≤28.1 g/L indicates that patients with THS may have a pooRprognosis.HB/ALB>3.3 indicates a higheRrisk of concomitant MOF,use of mechanical ventilation,and ICU admission.Dynamic monitoring of ALB and HB/ALB is meaningful foRassessing and guiding the resuscitation.