血浆肾素与动脉血乳酸水平评估低血压危重症患者预后的价值

The value of plasma renin and blood lactic acid levels in evaluating the prognosis of critically ill patients with hypotension

目的探讨血浆肾素浓度(PRC)与动脉血乳酸(Lac)水平评估低血压危重症患者预后的价值.方法选择2023年3月-2024年3月韶关市第一人民医院重症医学科病房(ICU)收治的102例低血压危重症患者为研究对象,根据患者入院后28d生存情况分为预后良好组与预后不良组,在ICU治疗期间,收集患者临床资料,重点比较组间PRC及Lac水平差异,回归分析PRC及Lac水平与预后的关系.绘制受试者工作特征(ROC)曲线,评价PRC与Lac水平对低血压危重症患者预后的评估价值.结果102例低血压危重症患者28d病死46例,病死率为45.10%.预后不良组年龄、急性生理与慢性健康状况评分系统(APACHEⅡ)评分、C反应蛋白(CRP)水平高于预后良好组(P<0.05),外周灌注指数(PPI)、白蛋白(ALB)水平低于预后良好组(P<0.05).两组患者PRC及Lac水平组间、时点、交互比较均有差异(P<0.05),组内比较:与入院时比较,入院后各时点的PRC及Lac水平降低:入院72h<入院48h<入院24h<入院12h(P<0.05);组间比较:预后不良组各时点PRC、Lac均高于预后良好组(P<0.05).经Logistic回归分析,PPI、CRP、ALB、入院时PRC、入院时Lac均与低血压危重症患者预后有关(P<0.05);绘制ROC曲线,结果显示,入院时PRC、Lac预测低血压危重症患者预后风险的曲线下面积(AUC)分别为0.753、0.760,预测价值一般,二者联合预测的AUC为0.819,预测价值更理想.结论低血压危重症患者预后不良可能与PRC和Lac表达上调有关,二者联合检测可用于预测低血压危重症患者入院后28d病死风险.

Objective To explore the prognostic value of plasma renin concentration(PRC)and blood lactic acid(Lac)levels in critically ill patients with hypotension.Methods 102 critically ill patients with hypotension admitted to the Intensive Care Unit(ICU)of the First People's Hospital of Shaoguan City from March 2023 to March 2024 were selected as the research subjects.According to the 28 day survival status of the patients,they were divided into a good prognosis group and a poor prognosis group.During the ICU treatment period,clinical data of the patients were collected,with a focus on comparing the differences in PRC and Lac levels between the groups,and conducting regression analysis on the relationship between PRC and Lac levels and prognosis.Draw receiver operating characteristic(ROC)curves to evaluate the prognostic value of PRC and Lac levels in critically ill patients with hypotension.Results Among 102 critically ill patients with hypotension,46 died within 28 days,with a mortality rate of 45.10%.The age,acute physiological and chronic health status scoring system(APACHEⅡ)score,and C-reactive protein(CRP)levels of the poor prognosis group were higher than those of the good prognosis group(P<0.05),while peripheral perfusion index(PPI)and albumin(ALB)levels were lower than those of the good prognosis group(P<0.05).There were differences in PRC and Lac levels between the two groups of patients at different time points and interactions(P<0.05).Intragroup comparison:compared with the time of admission,the PRC and Lac levels decreased at each time point after admission:72 hours<48 hours<24 hours<12 hours(P<0.05).Inter group comparison:the PRC and Lac in the poor prognosis group were higher than those in the good prognosis group at all time points(P<0.05).Logistic regression analysis showed that PPI,CRP,ALB,PRC at admission,and Lac at admission were all associated with the prognosis of critically ill patients with hypotension(P<0.05).ROC curves were drawn,the results showed that the area under the curve(AUC)of PRC and Lac predicting the prognostic risk of critically ill patients with hypotension at enrollment were 0.753 and 0.760,respectively,with average predictive value.The AUC predicted by the combination of the two was 0.819,indicating a more ideal predictive value.Conclusion The poor prognosis of critically ill patients with hypotension may be related to the upregulation of PRC and Lac expression,and the combined detection of the two can be used to predict the 28 day mortality risk of critically ill patients with hypotension after admission.