PDF(Pubmed)
Abstract：
BACKGROUND: There is no evidence to determine the association between the lactate dehydrogenase to albumin ratio (LAR) and the development of sepsis-associated acute kidney injury (SAKI). We aimed to investigate the predictive impact of LAR for SAKI in patients with sepsis.
METHODS: A total of 4,087 patients with sepsis from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were included. Logistic regression analysis was used to identify the association between LAR and the risk of developing SAKI, and the relationship was visualized using restricted cubic spline (RCS). The clinical predictive value of LAR was evaluated by ROC curve analysis. Subgroup analysis was used to search for interactive factors.
RESULTS: The LAR level was markedly increased in the SAKI group (p < 0.001). There was a positive linear association between LAR and the risk of developing SAKI (p for nonlinearity = 0.867). Logistic regression analysis showed an independent predictive value of LAR for developing SAKI. The LAR had moderate clinical value, with an AUC of 0.644. Chronic kidney disease (CKD) was identified as an independent interactive factor. The predictive value of LAR for the development of SAKI disappeared in those with a history of CKD but remained in those without CKD.
CONCLUSIONS: Elevated LAR 12 h before and after the diagnosis of sepsis is an independent risk factor for the development of SAKI in patients with sepsis. Chronic comorbidities, especially the history of CKD, should be taken into account when using LAR to predict the development of AKI in patients with sepsis.
METHODS: A total of 4,087 patients with sepsis from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were included. Logistic regression analysis was used to identify the association between LAR and the risk of developing SAKI, and the relationship was visualized using restricted cubic spline (RCS). The clinical predictive value of LAR was evaluated by ROC curve analysis. Subgroup analysis was used to search for interactive factors.
RESULTS: The LAR level was markedly increased in the SAKI group (p < 0.001). There was a positive linear association between LAR and the risk of developing SAKI (p for nonlinearity = 0.867). Logistic regression analysis showed an independent predictive value of LAR for developing SAKI. The LAR had moderate clinical value, with an AUC of 0.644. Chronic kidney disease (CKD) was identified as an independent interactive factor. The predictive value of LAR for the development of SAKI disappeared in those with a history of CKD but remained in those without CKD.
CONCLUSIONS: Elevated LAR 12 h before and after the diagnosis of sepsis is an independent risk factor for the development of SAKI in patients with sepsis. Chronic comorbidities, especially the history of CKD, should be taken into account when using LAR to predict the development of AKI in patients with sepsis.
摘要：
背景：没有证据确定乳酸脱氢酶与白蛋白比值（LAR）与脓毒症相关的急性肾损伤（SAKI）的发展之间的关联。我们旨在研究LAR对脓毒症患者SAKI的预测影响。
方法：纳入来自重症监护医学信息集市IV（MIMICIV）数据库的4,087例脓毒症患者。使用Logistic回归分析来确定LAR与发生SAKI的风险之间的关联。并使用受限三次样条（RCS）可视化关系。采用ROC曲线分析评价LAR的临床预测价值。亚组分析用于搜索交互因素。
结果：SAKI组LAR水平明显升高（p<0.001）。LAR与发生SAKI的风险之间存在正线性相关（非线性p=0.867）。Logistic回归分析显示LAR对SAKI的发展具有独立的预测价值。LAR具有中等临床价值，AUC为0.644。慢性肾脏病（CKD）被确定为独立的相互作用因素。LAR对SAKI发展的预测价值在有CKD病史的人群中消失，但在没有CKD的人群中仍然存在。
结论：脓毒症诊断前后12hLAR升高是脓毒症患者发生SAKI的独立危险因素。慢性合并症,尤其是CKD的历史，当使用LAR预测脓毒症患者AKI的发展时，应该考虑这些因素。
方法：纳入来自重症监护医学信息集市IV（MIMICIV）数据库的4,087例脓毒症患者。使用Logistic回归分析来确定LAR与发生SAKI的风险之间的关联。并使用受限三次样条（RCS）可视化关系。采用ROC曲线分析评价LAR的临床预测价值。亚组分析用于搜索交互因素。
结果：SAKI组LAR水平明显升高（p<0.001）。LAR与发生SAKI的风险之间存在正线性相关（非线性p=0.867）。Logistic回归分析显示LAR对SAKI的发展具有独立的预测价值。LAR具有中等临床价值，AUC为0.644。慢性肾脏病（CKD）被确定为独立的相互作用因素。LAR对SAKI发展的预测价值在有CKD病史的人群中消失，但在没有CKD的人群中仍然存在。
结论：脓毒症诊断前后12hLAR升高是脓毒症患者发生SAKI的独立危险因素。慢性合并症,尤其是CKD的历史，当使用LAR预测脓毒症患者AKI的发展时，应该考虑这些因素。
