Blood urea nitrogen to serum albumin ratio is a predictor of in-mortality in patients with COPD exacerbation requiring invasive mechanical ventilation
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摘要: 目的:探讨血尿素氮与血清白蛋白比值(B/A)在评估慢性阻塞性肺疾病急性加重(AECOPD)合并有创机械通气(IMV)患者住院病死率的价值。方法:回顾性观察性研究,收集本院急危重症医学科158例AECOPD合并IMV患者的临床资料,根据患者住院期间生存状态分生存组和死亡组,使用受试者工作曲线下面积(AUC)及logistic回归分析与评价B/A评估患者住院病死率的评估价值。结果:生存组(n=122)和死亡组(n=36)的血尿素氮、血清白蛋白、B/A比较,差异有统计学意义(P<0.001),B/A预测患者的住院病死率AUC是0.761(95%CI:0.686~0.825),与APACHEⅡ评分相当[0.782(95%CI:0.709~0.844)],差异无统计学意义(Z=0.382,P=0.703);多因素Logistic回归分析结果显示B/A(OR=4.370,95%CI:1.647~11.592)和APACHEⅡ评分(OR=1.299,95%CI:1.147~1.472)是患者死亡的独立危险因素。结论:B/A作为一个简便实用的工具,在评估AECOPD合并IMV患者住院病死率有一定价值,B/A≥0.33是患者死亡的独立危险因素。Abstract: Objective: This study aimed to evaluate the blood urea nitrogen to serum albumin(B/A) ratio as a predictor of in-hospital mortality in patients with COPD exacerbation requiring invasive mechanical ventilation(IMV).Methods: A retrospective observational study was conducted to investigated the clinical data of 158 AECOPD patients requiring IMV in our hospital. According to the survival status of patients during hospitalization, they were divided into survival group and death group. The area under the receiver operating characteristic curve(AUC) was used to determine the predictive value of B/A, and logistic regression was performed to evaluate the risk factors.Results: There were significant differences in BUN, Alb, B/A levels between the survival group and the death group(P<0.001); AUC of B/A was 0.761(95%CI: 0.686-0.825), which was equivalent to the APACHE Ⅱ score of 0.782(95%CI: 0.709-0.844), the difference was not statistically significant(Z=0.382, P=0.703). Multivariate logistic regression analysis showed that B/A(OR=4.370, 95%CI: 1.647-11.592), APACHE Ⅱ(OR=1.299, 95%CI: 1.147-1.472) were independent risk factors for death.Conclusion: B/A can be used as a simple and practical tool to predict the hospital mortality of AECOPD patients requiring IMV, and B/A≥0.33 is an independent risk factor for death.
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