摘要
目的评估血清阴离子间隙(AG)与危重患者住院病死率的关系。方法回顾性纳入来自重症监护病房合作研究数据库(eICU-Collaborative Research Database,eICU-CRD)中仅有一次ICU住院记录且在入ICU后首个24 h内有血清[Na^(+)]、[K^(+)]、[Cl^(-)]和[HCO^(-)_(3)]记录的成年ICU患者。本研究AG(mEq/L)=([Na^(+)]+[K^(+)])mEq/L-([Cl^(-)]+[HCO^(-)_(3)])mEq/L,并用血清白蛋白计算校正AG(cAG),即cAG=AG(mEq/L)+2.5×[4.4-血清白蛋白(g/dL)]。构建单因素和多因素Logistic回归模型,探讨患者入ICU后初始血清cAG与医院病死率的关系。在不同血乳酸(Lac)浓度亚组(Lac<2 mmol/L,2≤Lac≤5 mmol/L和Lac>5 mmol/L)中进一步分析cAG与住院病死率的关系。结果共纳入7379例成年ICU患者。初步分析发现,死亡患者cAG高于生存者(mEq/L:22.26±6.20 vs.19.49±5.51,P<0.001)。单因素Logistic回归模型显示,ICU患者cAG每升高1 mEq/L,其住院死亡风险增加1.082倍(95%CI 1.073~1.092)。在校正了年龄、种族、性别、急性生理学和慢性健康状况评估系统Ⅳ(APACHEⅣ)评分、心力衰竭、肾衰竭、呼吸衰竭、凝血障碍、脓毒症、休克、肝脏疾病、创伤、血Lac水平及pH后,cAG与住院病死率之间的上述相关性仍然存在(OR=1.017,95%CI 1.006~1.029)。根据cAG三分位数将研究人群分为三组,即cAG≤17.40 mEq/L组、17.40 mEq/L<cAG≤21.55 mEq/L组及cAG>21.55 mEq/L组。多因素分析显示,cAG>21.55 mEq/L组患者(OR=1.452,95%CI 1.239~1.700)医院死亡风险仍高于cAG≤17.40 mEq/L组。而亚组分析中发现,只有在血Lac为2~5 mmol/L的亚组中,cAG和住院病死率的相关性有统计学意义(17.40 mEq/L<cAG≤21.55 mEq/L:OR=1.290,95%CI 1.008~1.651;cAG>21.55 mEq/L:OR=1.929,95%CI 1.50~2.480)。结论入ICU后初始血清cAG升高与住院死亡的高风险相关,尤其是血Lac为2~5 mmol/L的患者。
Objective To evaluate the association between serum anion gap(AG)and hospital mortality of critically ill patients in Intensive Care Unit(ICU).Methods Adult ICU patients who had only one ICU admission record and had serum[Na^(+)],[K^(+)],[Cl^(-)],and[HCO^(-)_(3)]records during the first 24 hours after ICU admission were enrolled from eICU-Collaborative Research Database(eICU-CRD).In this study,AG was calculated as AG(mEq/L)=([Na^(+)]+[K^(+)])(mEq/L)-([Cl^(-)]+[HCO^(-)_(3)])(mEq/L),and corrected AG(cAG)was calculated as cAG=AG(mEq/L)+2.5×[4.4-serum albumin(g/dL)].Univariate and multivariate Logistic regression models were established to explore the relationship between initial serum cAG and hospital mortality.After that,subgroup analysis was performed based on serum lactate(Lac)(Lac<2 mmol/L,2≤Lac≤5 mmol/L,and Lac>5 mmol/L).Results A total of 7379 adult ICU patients were enrolled.The dead patients had the higher cAG than the survivors(mEq/L:22.26±6.20 vs.19.49±5.51,P<0.001).The risk of hospital mortality increased with the increase of cAG,with a OR and 95%CI was 1.082(1.073-1.092)for every 1 mEq/L increase in cAG.After adjusting for age,sex,ethnicity,APACHEⅣscores,heart failure,renal failure,respiratory failure,coagulopathy,sepsis,shock,liver disease,trauma,serum Lac,and pH,the association between cAG and hospital mortality still existed(OR=1.017,95%CI 1.006-1.029).In order to further explore the correlation between cAG and hospital mortality,the participants were divided into three groups according to the tertiles of cAG(cAG≤17.40 mEq/L,17.40 mEq/L<cAG≤21.55 mEq/L,cAG>21.55 mEq/L).Multivariate Logistic regression models showed that the hospital mortality was higher in cAG>21.55 mEq/L(OR=1.452,95%CI 1.239-1.700)than in the cAG≤17.40 mEq/L.In subgroup analysis,the association between cAG and hospital mortality was statistically significant only in the subgroup with serum Lac of 2-5 mmol/L(17.40 mEq/L<cAG≤21.55 mEq/L:OR=1.290,95%CI 1.008-1.651;cAG>21.55 mEq/L:OR=1.929,95%CI 1.501-2.480).Conclusions
作者
冯辉
李若寒
高雅
张静静
李佳媚
王岗
Feng Hui;Li Ruo-han;Gao Ya;Zhang Jing-jing;Li Jia-mei;Wang Gang(Department of Critical Care Medicine,the Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China)
出处
《中国急救医学》
CAS
CSCD
2022年第1期41-46,共6页
Chinese Journal of Critical Care Medicine
