摘要
目的探讨白蛋白校正阴离子间隙(ACAG)与重症急性心肌梗死(AMI)患者近期预后的关系。方法回顾性分析美国重症监护医学信息数据库(MIMIC-Ⅲ)中2001年6月至2012年10月的AMI患者714例的临床资料,依据90 d的预后分为存活组和死亡组。根据ACAG水平分为正常ACAG组和高ACAG组。采用Kaplan-Meier生存曲线和log-rank检验分析ACAG与28及90 d的预后关系,应用Cox回归模型分析ACAG与AMI患者预后之间的关系,采用限制性立方样条(RCS)分析AMI患者ACAG与90 d全因死亡风险间的关系。结果死亡组患者年龄、序贯器官衰竭评分、急性生理学评分Ⅲ、ACAG、阴离子间隙、白细胞计数、肌酐、血钾、慢性肾脏病、心脏停搏比例高于存活组患者,重症医学科住院时间长于存活组患者,白蛋白、动脉血氧分压、血红蛋白、血总钙值、经皮冠状动脉介入治疗、冠状动脉造影、高血压、冠心病和高脂血症比例低于存活组患者,差异均有统计学意义(均P<0.05)。Kaplan-Meier生存曲线分析显示,与正常ACAG组比较,高ACAG组患者28和90 d累积生存率较低,差异均有统计学意义(均P<0.001)。多因素Cox回归分析显示高ACAG是AMI患者28和90 d全因死亡的独立危险因素(均P<0.05)。RCS表明AMI患者ACAG与90 d全因死亡风险间呈非线性趋势(P<0.05)。结论ACAG水平升高与重症AMI患者近期不良预后相关。
Objective To explore the correlation between albumin corrected anion gap(ACAG)and short-term outcome of critically ill patients with acute myocardial infarction(AMI).Methods The clinical data of 714 AMI patients from June 2001 to October 2012 in Medical Information Mart for Intensive CareⅢ(MIMIC-Ⅲ)were analyzed retro-spectively.The patients were divided into survival group and death group based on 90-day outcome,and divided into normal ACAG group and higher ACAG group based on ACAG level.Kaplan-Meier survival curve and log-rank test were used to analyze the relation between ACAG and 28-day and 90-day outcomes.Cox proportional-hazards regression model was used to analyze the correlation between ACAG and patients'outcomes.Restricted cubic spline(RCS)was used to analyze the relation between ACAG and the risk of 90-day all-cause mortality in AMI patients.Results The age,SOFA score,acute physiology scoreⅢ,ACAG,anion gap,white blood cell,creatinine,potassium,and the proportion of chronic kidney disease and cardiac arrest,and ICU stay time in the death group were significantly higher than those in the survival group(all P<0.05),while albumin,arterial partial pressure of oxygen,hemoglobin,total calcium,and the proportion of percutaneous coronary intervention,coronary angiography,hypertension,coronary heart disease and hyperlipidemia were significantly lower than those in the survival group(all P<0.05).Kaplan-Meier survival curve and log-rank test showed that the 28-and 90-day cumulative survival rates were significantly lower in the high ACAG group than in the normal ACAG group(both P<0.001).The multivariate Cox proportional-hazards regression model showed high ACAG was an independent risk factor for all-cause mortality(both P<0.05).RCS showed a non-linear relationship between ACAG and 90-day all-cause mortality in AMI patients.Conclusion Increased ACAG level is correlated to adverse short-term outcome of critically ill patients with AMI.
作者
沈其锴
钟磊
姬晓伟
谢波
SHEN Qikai;ZHONG Lei;JI Xiaowei;XIE Bo(Department of Intensive Care Unit,Huzhou Central Hospital(the Affiliated Huzhou Hospital of Zhejiang University School of Medicine),Huzhou 313000,China)
出处
《心电与循环》
2024年第6期550-554,共5页
Journal of Electrocardiology and Circulation
基金
浙江省基础公益研究计划项目(LGD20H150001)
浙江省医药卫生科技计划项目(2023KY314)。
关键词
白蛋白校正阴离子间隙
急性心肌梗死
预后
Albumin corrected anion gap
Acute myocardial infarction
Prognosis
