摘要
目的:探讨尿素/肌酐比值(UCR)与合并急性呼吸衰竭的脓毒症病人不良预后的相关性。方法:纳入美国重症监护医学信息数据库(MIMIC-Ⅳ)中合并急性呼吸衰竭的脓毒症病人,收集其人口统计学信息、入ICU后24 h内的实验室检查、合并症、动脉血气分析、ICU期间的治疗、疾病严重程度评分等。根据入ICU时UCR四分位数水平对病人进行分组,以90 d死亡作为主要结局指标。对比各组病人的临床基线资料和预后指标。并采用Logistic回归分析和限制性立方样条分析评估UCR水平与脓毒症病人预后的关系。结果:共纳入4476名病人,高UCR组病人的院内、28 d、60 d及90 d死亡率显著增加(P<0.001)。通过Boruta算法及随机森林选择重要的特征变量,构建Logistic回归模型发现U3组及U4组病人90 d死亡风险显著增高(OR=1.311,95%CI:1.065~1.614,P=0.011;OR=1.745,95%CI:1.412~2.157,P<0.001)。限制性立方样条分析显示UCR水平与病人死亡风险呈线性正相关。结论:高UCR与合并急性呼吸衰竭的脓毒症病人预后显著相关。
Objective:To investigate the correlation between urea/creatinine ratio and poor prognosis of sepsis patients with acute respiratory failure.Methods:We enrolled sepsis patients with acute respiratory failure in the Medical Information Mart for Intensive CareⅣ(MIMIC-Ⅳ).Demographic characteristics,laboratory parameters within the first 24 hours after ICU admission,comorbidities,arterial blood gas analysis,therapeutic managements strategies and disease severity scores were recorded.Patients were categorized based on the quartiles of UCR.The primary outcome was 90-day mortality.Baseline clinical characteristics and patient outcomes were compared across groups.Subsequently,Multivariable logistic regression analysis and restricted cubic spline models were employed to explore the association between UCR and prognosis in sepsis patients with acute respiratory failure.Results:A total of 4476 patients were included,and patients with high UCR had higher in-hospital,28day,60-day and 90-day mortality as compared to the other subgroups(P<0.001).Through variable selection selected by Boruta algorithm and random forest,we constructed logistic regression model and found that U3 and U4 group were associated with a significantly higher risk of 90-day mortality(OR=1.311,95%CI:1.065~1.614,P=0.011;OR=1.745,95%CI:1.412~2.157,P<0.001).Restricted cubic spline analysis demonstrated a linear positive correlation between UCR and in-hospital,28-day,60-day and 90-day mortality.Conclusions:Elevated UCR level was associated with a significantly higher mortality in sepsis with acute respiratory failure.
作者
陈鑫
王新颖
CHEN Xin;WANG Xin-ying(Department of General Surgery,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,Jiangsu,China)
出处
《肠外与肠内营养》
北大核心
2025年第4期208-215,共8页
Parenteral & Enteral Nutrition
基金
江苏省科技计划社会发展—临床前沿技术项目(BE2022822)。
作者简介
通讯作者:王新颖,E-mail:wangxinying@nju.edu.cn。
