摘要
目的探讨乳酸脱氢酶(LDH)与白蛋白比值(LAR)联合急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)对女性生殖系统和乳腺恶性肿瘤重症患者预后的预测价值。方法通过美国重症监护医学信息数据库(2.0版)获取2008年至2019年在ICU住院的女性生殖系统恶性肿瘤重症患者144例和乳腺恶性肿瘤重症患者360例共计491例的临床数据。依据随访1年时的预后情况,分为生存组249例和死亡组242例,比较两组患者的临床资料。应用Kaplan-Meier法绘制生存曲线,运用单因素和多因素Cox回归分析探讨入ICU时LAR与患者临床结局间的关系。采用ROC曲线评估LAR、APACHEⅡ评分以及两者联合预测患者预后的效能。结果死亡组患者APACHEⅡ评分、LDH、LAR、红细胞分布宽度、AST、肌酐、PT均高于生存组,机械通气、肾脏替代治疗、去甲肾上腺素、心源性休克、脓毒性休克和急性肾损伤比例均高于生存组,而白蛋白和RBC均低于生存组,差异均有统计学意义(均P<0.05)。生存曲线分析显示,随着LAR值的升高,患者的累积生存率降低,差异均有统计学意义(均P<0.01)。多因素Cox回归分析显示,高LAR水平(>15.51)是整体女性生殖系统和乳腺恶性肿瘤重症患者1年全因死亡率的独立危险因素(HR=2.495,95%CI:1.576~3.950,P<0.01)。女性生殖系统和乳腺恶性肿瘤重症患者的亚组分析结果也相似。ROC曲线分析结果表明,LAR、APACHEⅡ评分及两者联合预测女性生殖系统和乳腺恶性肿瘤重症患者1年全因死亡率的AUC分别为0.666、0.673和0.689,两者联合预测的AUC均优于APACHEⅡ评分、LAR单独预测。结论LAR水平增高是女性生殖系统和乳腺恶性肿瘤重症患者死亡风险增加的独立危险因素,联合APACHEⅡ评分对这类患者的预后有一定的预测价值。
Objective To investigate the predictive value of lactate dehydrogenase(LDH)to albumin ratio(LAR)combined with acute physiology and chronic health evaluation scoreⅡ(APACHEⅡ)on the prognosis of female critically ill patients with reproductive tract cancers and breast cancer.Methods Data on 491 female patients diagnosed with reproductive tract cancers(144 cases)and breast cancer(360 cases)who admitted to the intensive care unit(ICU)from 2008 to 2019 were obtained from the Multiparameter Intelligent Monitoring in Intensive Care IV database(MIMIC-IV)(version 2.0)and retrospectively analyzed.Based on the prognosis at 1 year of follow-up,the patients were categorized into the survival group(249 patients)and the death group(242 patients),and the clinical data of the two groups were compared.The Kaplan-Meier method was applied to draw cumulative survival curves,and univariate and multivariate Cox regressions were utilized to explore the relationship between LAR at the time of admission to ICU and the clinical outcomes of these patients.Meanwhile,subgroup analyses were applied to verify the stability of the study result.Receiver operating characteristic(ROC)curve was used to further assess the efficacy of LAR,APACHEⅡscore,and the combined metrics in predicting the prognosis of female critically ill patients with reproductive tract cancers and breast cancer.Results Patients in the death group had higher APACHEⅡscores,LDH,LAR,erythrocyte distribution width,AST,creatinine,and prothrombin time(PT)than those in the survival group,and higher proportions of mechanical ventilation,renal replacement therapy,norepinephrine,cardiogenic shock,septic shock,and acute kidney injury;whereas,the values of albumin and erythrocytes were lower,and the differences between the groups were statistically significant(all P<0.05).Both the overall analysis and the subgroup survival curves suggested that the cumulative survival of patients was lower as the LAR value increased(all P<0.01).Multifactorial Cox regression analysis showed that high
作者
王海丽
邱建
原梦
何惠
黄筱竑
WANG Haili;QIU Jian;YUAN Meng;HE Hui;HUANG Xiaohong(Department of Obstetrics and Gynecology,Huzhou Central Hospital(The Affiliated Huzhou Hospital of Zhejiang University School of Medicine),Huzhou 313000,China;不详)
出处
《浙江医学》
CAS
2023年第22期2392-2397,共6页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2022KY357)
湖州市科技计划项目(2020GYB06)。
