心源性休克合并急性肾损伤患者血尿素氮与白蛋白比值与预后的关系研究

The relationship between blood urea nitrogen-to-albumin ratio and prognosis of patients with cardiogenic shock combined with acute kidney injury

目的探讨心源性休克(CS)合并急性肾损伤(AKI)患者尿素氮(BUN)与白蛋白(ALB)比值(BAR)与预后的关系。方法回顾性选取2008至2019年美国重症监护数据库Ⅳv2.0中713例入住重症监护室(ICU)的CS合并AKI患者临床资料。根据入住ICU时BAR的四分位数分为<0.215组178例、0.215~<0.322组178例、0.322~<0.519组178例和≥0.519组179例。根据90 d预后情况分为存活组364例和死亡组349例。比较不同BAR患者90 d累积生存率;比较存活组与死亡组患者临床资料;采用Cox比例风险回归模型分析CS合并AKI患者90 d内全因死亡的独立影响因素。结果不同BAR患者90 d累积生存率比较,差异有统计学意义(P<0.001)。死亡组患者在年龄、急性生理学和慢性健康状况评价Ⅱ评分、BUN、BAR、白细胞计数、碱性磷酸酶、肌酐、血磷、乳酸,合并恶性肿瘤、心脏骤停比例以及采用去甲肾上腺素、血管加压素、肾脏替代治疗比例均明显高于存活组(均P<0.05),ALB、红细胞计数、血小板计数、碳酸氢根,合并充血性心力衰竭、冠状动脉搭桥术后比例以及采用临时心脏起搏、主动脉内球囊反搏比例均明显低于存活组(均P<0.05)。BAR≥0.519是CS合并AKI患者90 d全因死亡的独立危险因素(HR=1.646,P=0.013)。结论入住ICU时BAR≥0.519预示CS合并AKI患者近期预后不良。

Objective To explore the correlation between blood urea nitrogen(BUN)to albumin(ALB)ratio(BAR)and prognosis of patients with cardiogenic shock(CS)combined with acute kidney injury(AKI).Methods A retrospective analysis was conducted on clinical data of 713 CS and AKI patients admitted to the intensive care unit(ICU)extracted from the US Medical Information Mart of Intensive CareⅣv2.0 between 2008 and 2019.According to BAR quartiles at ICU admission,patients were divided into four groups:<0.215 group(n=178),0.215~<0.322 group(n=178),0.322~<0.519 group(n=178),and≥0.519(n=179)group.Based on the 90-day outcome,the patients were divided into survival group(n=364)and death group(n=349).The 90-day cumulative survival rates were compared among different BAR groups.The clinical data between the survivors and non-survivors were analyzed.Cox proportional hazards regression model was used to analyze risk factors for all-cause mortality within 90 days.Results There was a significant difference in 90-day cumulative survival rate among patients in different BAR groups(P<0.001).Age,Acute Physiology And Chronic Health EvaluationⅡ(APACHEⅡ)score,BUN,BAR,white blood cell count,alkaline phosphatase,creatinine,blood phosphorus,lactate,the proportions of malignant tumors and cardiac arrest,the use of norepinephrine,vasopressin and renal replacement therapy were significantly higher in death group than in survival group(all P<0.05),while ALB,red blood cell count,platelet count,bicarbonate level,and the proportions of congestive heart failure and coronary artery bypass grafting,the use of temporary cardiac pacing and intra-aortic balloon counterpulsation were significantly lower compared to the survival group(all P<0.05).BAR≥0.519 was an independent risk factor for 90-day all-cause mortality(HR=1.646,P=0.013).Conclusion BAR≥0.519 at ICU admission indicates poor short-term prognosis in patients with CS combined with AKI.