摘要
目的 研究红细胞分布宽度-白蛋白比值(red cell distribution width-albumin ratio,RAR)与老年危重症患者病死率的相关性。方法 采用回顾性队列研究设计,选择2007年—2020年重症监护室医学信息(Medical Information Mart for Intensive Care,MIMIC)数据库中所有符合纳入标准的患者作为研究对象,根据RAR三分位间距将其分成三组。比较分析三组一般资料,绘制Kaplan-Meier生存曲线评估不同RAR组患者28d病死率。采用Cox比例风险回归模型确定RAR与病死率的校正风险比。绘制限制性立方样条研究RAR作为连续变量对病死率的影响。亚组分析采用层次回归模型。结果 共12 293例患者纳入研究,其中RAR≤4.09组4 114例,4.09 5.31组4 086例。Kaplan-Meier生存曲线显示RAR>5.31组28d病死率最高(34.04%)。单因素Cox回归分析发现RAR与28d病死率相关(HR=1.24,95%CI:1.22~1.26,P<0.001)。Cox回归模型发现,调整潜在混杂因素后高RAR仍然是28d病死率的独立危险因素(HR=1.15,95%CI:1.13~1.18,P<0.001)。亚组分析显示RAR对28d病死率的影响效应在年龄、血小板、性别等亚组高(P<0.05)。限制性立方样条显示RAR与28d病死率基本呈线性正相关。结论 高RAR水平是老年危重症患者病死率的独立危险因素。
Objective To investigate the correlation between red cell distribution width-albumin ratio(RAR)and mortality in elderly critically ill patients.Methods All patients who met the inclusion criteria in the MIMIC(Medical Information Mart for Intensive Care)database were selected as study subjects from 2007 to 2020 and divided into three groups based on the RAR interquartile range.General data for the three groups were compared and analyzed,and Kaplan-Meier curves were used to evaluate 28d mortality in patients with different RARs.Cox proportional hazard regression models were used to determine the adjusted hazard ratios of RAR and mortality.Restricted cubic spline was used to assess the continuous effect of RAR on mortality.Subgroup analysis was performed using a hierarchical regression model.Results A total of 12293 patients were included in the study,with 4114 in the RAR≤4.09 group,4093 in the 4.09<RAR≤5.31 group,and 4086 in the RAR>5.31 group.Kaplan-Meier curves showed that the RAR>5.31 group had the highest 28-day mortality.Univariate Cox regression analysis showed that RAR was associated with 28-day mortality(HR=1.24,95%CI:1.22-1.26,P<0.001).Cox regression analysis showed that high RAR remained an independent predictor of 28-day mortality after adjusting for potential confounding factors(HR=1.15,95%CI:1.13-1.18,P<0.001).Subgroup analysis showed that RAR was similar in most covariates(P>0.05).Restricted cubic spline basically demonstrated a linear positive correlation between RAR and 28-day mortality.Conclusions High RAR level is an independent risk factor for mortality in elderly critically ill patients.
作者
张舒
陈影
李佳俊
黄文祥
罗华婷
Zhang Shu;Chen Ying;Li Jiajun;Huang Wenxiang;Luo Huating(Department of Hepatological Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400013,China;Department of Hematopathology,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Infectious Disease,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400013,China;Department of Geriatrics,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400013,China)
出处
《中国医学前沿杂志（电子版）》
CSCD
2023年第10期33-40,共8页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
重庆市科委自然科学基金项目(cstc2019jcyj-msxmX0829)。
关键词
红细胞分布宽度-白蛋白比值
老年危重症患者
病死率
Red cell distribution width-albumin ratio
Critically ill elderly patients
Mortality rate
