摘要
目的探讨红细胞分布宽度与白蛋白比值(RAR)在评估重症急性胰腺炎(SAP)患者预后中的作用。方法采用美国MIMICIV数据库,对638例SAP患者进行回顾性分析。根据180 d的预后,患者被分为存活组和死亡组。采用限制性立方样条(RCS)分析RAR与死亡风险的非线性关系,并根据RAR的三分位数,将患者分三组:低RAR组(<4.22)、中RAR组(4.22~5.39)和高RAR组(>5.39)。通过Kaplan-Meier生存曲线与Log-rank检验评估RAR对生存率的影响,建立Cox回归风险模型,并绘制ROC曲线以评价RAR的预测能力。结果死亡组在RAR、年龄、SOFA评分、APSⅢ评分、白细胞计数等方面均显著高于存活组,并更频繁地使用去甲肾上腺素、机械通气和肾脏替代治疗,而白蛋白、红细胞及血小板计数均低于存活组(P<0.05)。RCS分析显示,RAR与180 d全因死亡风险之间呈非线性关系。Kaplan-Meier生存曲线表明,高RAR组在180 d和360 d累积生存率均明显低于中RAR组和低RAR组,差异有统计学意义(P<0.05)。Cox回归模型确认高RAR水平(>5.39)是180 d和360 d预后不良的独立危险因素。ROC曲线分析提示,RAR结合SOFA评分的预测效能优于单一因素。结论入院时RAR水平的升高(>5.39)是SAP患者不良中长期预后的独立预测因子,结合SOFA评分的RAR能显著提高预后评估的准确性,对临床护理管理具有重要指导意义。
Objective To explore the role of the red cell distribution width to albumin ratio(RAR)in assessing the prognosis of patients with severe acute pancreatitis(SAP).Methods A retrospective analysis was conducted on 638 SAP patients using the American MIMIC-IV database.Patients were divided into the survival and the death groups based on the prognosis within 180 days.The non-linear relationship between RAR and the risk of death was analyzed using restricted cubic splines(RCS).Patients were divided into three groups according to the tertiles of RAR:the low RAR group(<4.22),the medium RAR group(4.22~5.39),and the high RAR group(>5.39).The impact of RAR on survival rate was assessed using Kaplan-Meier survival curves and Log-rank tests.A Cox regression risk model was established,and receiver operating characteristic(ROC)curves were plotted to evaluate the predictive ability of RAR.Results The death group had significantly higher RAR,age,SOFA score,APACHE III score,white blood cell count,and more frequent use of norepinephrine,mechanical ventilation,and renal replacement therapy than the survival group,while albumin,red blood cells,and platelet counts were lower than the survival group(P<0.05).RCS analysis showed a non-linear relationship between RAR and the risk of all-cause mortality within 180 days.Kaplan-Meier survival curves indicated that the high RAR group had significantly lower cumulative survival rates at 180 and 360 days compared to the medium and low RAR groups,with statistically significant differences(P<0.05).The Cox regression model confirmed that a high RAR level(>5.39)was an independent risk factor for poor prognosis at 180 and 360 days.ROC curve analysis suggested that the predictive performance of RAR combined with the SOFA score was superior to that of a single factor.Conclusion Elevated RAR levels(>5.39)at admission are an independent predictor of poor mid-to-long term prognosis in SAP patients,and RAR combined with the SOFA score can significantly improve the accuracy of prognosis assessment,which is
出处
《浙江临床医学》
2024年第11期1592-1595,共4页
Zhejiang Clinical Medical Journal
基金
浙江省湖州市科技计划项目(2021GYB57)。
