摘要
目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 h内有血氨检测记录且入ICU未患有肝脏疾病的患者。提取患者的年龄、性别、种族、急性生理和慢性健康评分Ⅳ(APACHEⅣ评分)、肾脏替代治疗等治疗措施、基础患病情况及结局。采用单因素及多因素Logistic回归分析血氨水平与患者死亡风险之间的关系。采用交互作用分析初始血氨水平与患者死亡风险间的关系在不同APACHEⅣ评分、年龄、性别和种族患者中是否存在差异,同时进行亚组分析。结果共纳入1674名患者,多因素Logistic回归显示,初始血氨每增加10μg/dL,患者ICU死亡风险增高6.9%(OR=1.069,95%CI:1.036~1.104),患者医院死亡风险增高4.6%(OR=1.046,95%CI:1.017~1.076);初始血氨在49~82μg/dL组、≥82μg/dL组的患者ICU死亡风险和≥82μg/dL组患者医院死亡风险分别是<49μg/dL组患者的1.7倍(OR=1.700,95%CI:1.165~2.482)、2.862倍(OR=2.862,95%CI:1.792~4.570)、1.844倍(OR=1.844,95%CI:1.213~2.804)。初始血氨水平与ICU及医院死亡发生风险间的关系在不同APACHEⅣ评分、年龄、性别及种族患者中差异无统计学意义。结论在未患有肝脏疾病的重症患者中,入ICU后初始血氨水平升高与患者ICU及医院高死亡风险相关。
Objective To investigate the relationship between the initial serum ammonia level and the risk of ICU and hospital mortalities in critically ill patients without hepatic disease.Methods A retrospective cohort study was conducted among patients admitted to the eICU Collaborative Research Database(eICU-CRD) for a single admission who had serum ammonia test records within 48 hours of the first ICU admission and had no hepatic disease.The age,sex,ethnicity,Acute Physiologic and Chronic Health Evaluation Ⅳ score(APACHE Ⅳ score),treatment methods,complications,and outcomes were extracted.Univariable and multivariable Logistic regression were used to analyze the relationship between serum ammonia level and the risk of mortality.Interactions were used to analyze whether the relationship between serum ammonia level and the risk of mortality differed in subgroups of APACHE Ⅳ scores,age,sex,and ethnicity;subgroup analyses were made.Results A total of 1 674 patients were included.The multivariable Logistic regression showed that for every 10 μg/dL increase in ammonia,the risk of ICU death increased by 6.9%(OR=1.069,95% CI:1.036-1.104),and the risk of hospital death increased by 4.6%(OR=1.046,95% CI:1.017-1.076).The risk of ICU death was 1.7 times greater in patients with initial ammonia level of 49-82 μg/dL than in those with <49 μg/dL(OR=1.700,95% CI:1.165-2.482),the risk of ICU death was 2.862 times greater in patients with a level of ≥82 μg/dL compared to those with <49 μg/dL(OR=2.862,95% CI:1.792-4.570),and the risk of hospital death was 1.844 times higher in the ≥82 μg/dL group than in the <49 μg/dL group(OR=1.844,95% CI:1.213-2.804).There were no significant differences between initial ammonia level and the risk of mortalities in different subgroups of APACHEⅣ scores,age,sex,or ethnicity.Conclusion In critically ill patients without hepatic disease,elevated initial serum ammonia level after ICU admission is associated with a high risk of ICU and hospital mortality.
作者
秦赞
李佳媚
侯彦丽
高晓明
王岗
QIN Zan;LI Jiamei;HOU Yanli;GAO Xiaoming;WANG Gang(Department of Critical Care Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004;Department of Critical Care Medicine,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2024年第2期271-277,共7页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
陕西省“高层次人才特殊支持计划”青年拔尖人才项目
吴阶平医学基金会临床科研专项资助基金项目(No.320.6750.2021-08-2)。
作者简介
通信作者:王岗,教授,研究员,博士生导师,副主任医师.E-mail:gang_wang@xjtu.edu.cn。
