目的:脓毒症是急性肾损伤(AKI)的主要原因。越来越多的证据表明,血清总蛋白与白蛋白之比(TAR)可以作为各种疾病中基于炎症和营养的预后标志物。这项研究的目的是评估TAR在预测脓毒症AKI患者临床结局中的预后价值。
方法:回顾性纳入2015年8月至2022年8月在四川大学华西医院收治的脓毒症AKI患者。2015年8月至2021年8月期间收治的患者被定义为原始队列。主要结果是30天和90天全因感染性AKI患者的死亡率。次要结果是感染性休克,转移到重症监护室,机械通气,肾脏替代疗法的要求,第三阶段AKI。在2021年9月至2022年8月期间收治的感染性AKI患者的验证队列中进一步验证了TAR的实用性。
结果:在原始队列中,共纳入309名符合条件的患者,中位年龄为58岁,其中70.2%为男性。在多变量Cox分析中,经过年龄调整后,性别,和其他混杂因素,入院时TAR升高与脓毒症AKI患者30日和90日全因死亡率风险增加相关(HR1.91,95%CI1.18~3.09,P=0.008;HR1.54,95%CI1.01~2.34,P=0.043).亚组分析显示,在大多数地层中没有显着的相互作用。AKI诊断或出院时的TAR与30天死亡率(分别为P=0.120和0.153)或90天死亡率(分别为P=0.147和0.124)无显著相关性。我们发现基线TAR与感染性休克之间没有关系,转移到重症监护室,机械通气,肾脏替代疗法的要求,或3期AKI(均P>0.05)。在81例感染性AKI患者的验证队列中,入院时TAR仍然是30天和90天死亡率的重要预测指标(HR4.367,95%CI1.20-15.87,P=0.025;HR4.237,95%CI1.59-11.27,P=0.004)。
结论:入院时的TAR是脓毒症AKI患者30天和90天死亡率的独立危险因素,可作为一个方便、经济的脓毒症AKI预后指标。
OBJECTIVE: Sepsis is the leading cause of acute kidney injury (AKI). Increasing evidence shows that serum total protein-to-albumin ratio (TAR) could serve as an inflammation- and nutrition-based prognostic marker in various diseases. The purpose of this study was to assess the prognostic value of TAR in predicting the clinical outcomes of septic AKI patients.
METHODS: We retrospectively enrolled septic AKI patients between August 2015 and August 2022 at West China Hospital of Sichuan University. Patients admitted between August 2015 and August 2021 were defined as the original cohort. The primary outcomes were 30-day and 90-day all-cause mortality of septic AKI patients. The secondary outcomes were septic shock, transfer to the intensive care unit, mechanical ventilation, requirement for renal replacement therapy, and stage 3 AKI. The utility of TAR was further verified in a validation cohort of septic AKI patients admitted between September 2021 and August 2022.
RESULTS: In the original cohort, a total of 309 eligible patients with a median age of 58 years were enrolled, of which 70.2 % were males. In multivariate Cox analysis, after adjustments for age, sex, and other confounding factors, higher TAR at admission was associated with an increased risk of 30-day and 90-day all-cause mortality in septic AKI patients (HR 1.91, 95 % CI 1.18-3.09, P = 0.008; HR 1.54, 95 % CI 1.01-2.34, P = 0.043, respectively). Subgroup analysis revealed no significant interactions in most strata. TAR at AKI diagnosis or discharge was not significantly related to 30-day (P = 0.120 and 0.153, respectively) or 90-day mortality (P = 0.147 and 0.124, respectively). We found no relationship between baseline TAR and septic shock, transfer to the intensive care unit, mechanical ventilation, requirement for renal replacement therapy, or stage 3 AKI (all P > 0.05). In the validation cohort of 81 septic AKI patients, TAR at admission remained a significant prognosticator for 30-day and 90-day mortality (HR 4.367, 95 % CI 1.20-15.87, P = 0.025; HR 4.237, 95 % CI 1.59-11.27, P = 0.004).
CONCLUSIONS: TAR at admission is an independent risk factor for 30-day and 90-day mortality in septic AKI patients and could be used as a convenient and economic septic AKI prognostic indicator.