Evaluation of the short-term prognosis in patients after cardiopulmonary resuscitation using the combination of blood lactate-to-albumin ratio and D-dimer
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摘要: 目的 探讨血乳酸与白蛋白比值(lactate-to-albumin ratio，LAR)联合D-二聚体对院内心脏骤停(in-hospital cardiac arrest，IHCA)后患者短期预后的评估价值。方法 选取2017年7月—2024年6月哈尔滨医科大学附属第二医院收治的78例心肺复苏后自主循环恢复的患者进行回顾性研究，根据患者7 d内是否存活分为存活组和死亡组。收集患者的人口统计数据、合并症信息及实验室检查结果，包括乳酸、白蛋白、D-二聚体等，并计算LAR。采用logistic回归分析评估影响患者短期预后的独立危险因素，并建立列线图预测模型。结果 单因素和多因素logistic回归分析显示，LAR和D-二聚体是影响IHCA患者7 d预后的独立危险因素(P < 0.05)。基于LAR和D-二聚体构建的列线图预测模型显示出良好的预测性能，曲线下面积(AUC)为0.786(95%CI：0.685~0.882)，灵敏度为83.3%，特异度为66.7%。结论 血乳酸与白蛋白比值联合D-二聚体能够有效评估IHCA患者复苏后的短期预后，为临床决策提供参考。Abstract: Objective To evaluate the prognostic value of the lactate-to-albumin ratio(LAR) combined with D-dimer for short-term outcomes in patients after in-hospital cardiac arrest(IHCA).Methods A retrospective study was conducted among 78 patients who achieved return of spontaneous circulation(ROSC) following cardiopulmonary resuscitation(CPR) for IHCA at the Second Affiliated Hospital of Harbin Medical University from July 2017 to June 2024. Patients were divided into survival and non-survival groups based on their survival status within 7 days. Demographic data, comorbidity information, and laboratory test results including lactate, albumin, and D-dimer were collected, and the LAR was calculated. logistic regression analysis was used to identify independent risk factors affecting short-term prognosis, and a nomogram prediction model was established.Results Univariate and multivariate logistic regression analyses revealed that LAR and D-dimer were independent risk factors for 7-day mortality in IHCA patients(P < 0.05). The nomogram prediction model based on LAR and D-dimer exhibited good predictive performance, with an area under the curve(AUC) of 0.786(95%CI: 0.685-0.882), a sensitivity of 83.3%, and a specificity of 66.7%.Conclusion The combination of the lactate-to-albumin ratio and D-dimer effectively assesses the short-term prognosis of IHCA patients after resuscitation, providing valuable information for clinical decision-making.
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Key words:
- in-hospital cardiac arrest /
- lactate /
- albumin /
- D-dimer /
- short-term prognosis
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表 1 生存组与死亡组IHCA后ROSC患者一般资料比较
项目 存活组(36例) 死亡组(42例) P 年龄/岁 55.47±16.66 59.79±15.82 0.245 性别/例(%) 0.598 男 15(41.7) 20(47.6) 女 21(58.3) 22(58.4) 高血压/例(%) 8(22.2) 13(31.0) 0.386 糖尿病/例(%) 8(22.2) 8(19.0) 0.729 冠心病/例(%) 15(41.7) 20(47.6) 0.598 肺部感染/例(%) 14(38.9) 18(42.9) 0.722 脑血管病/例(%) 13(36.1) 13(31.0) 0.630 肾功能不全/例(%) 6(16.7) 10(23.8) 0.436 WBC/(×109/L) 16.78±7.30 17.20±10.94 0.844 NEUT/(×109/L) 14.39±6.57 13.61±10.47 0.698 LYMPH/(×109/L) 1.92±1.46 3.03±2.65 0.290 MONO/(×109/L) 0.39±0.34 0.48±0.53 0.415 PLT/(×109/L) 235.94±107.07 210.19±124.95 0.336 HGB/(g/L) 115.97±31.15 118.64±36.43 0.731 PT/(SEC) 12.99±3.19 18.88±23.52 0.141 FIB/(g/L) 3.25±1.11 2.89±1.18 0.171 D-D/(ng/mL) 3 491.39±3 845.35 10 051.54±12 978.62 0.005 Scr/(μmol/L) 245.78±328.43 233.55±168.98 0.833 乳酸/(mmol/L) 6.83±4.55 11.29±3.88 < 0.001 ALB/(g/L) 33.75±5.31 31.59±7.69 0.161 LAR 0.22±0.17 0.39±0.17 < 0.001 
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表 2 单因素及多因素logistic回归分析IHCA后ROSC患者7 d死亡的危险因素
变量 单因素logistic回归分析 多因素logistic回归分析 OR(95%CI) P OR(95%CI) P LYMPH 1.292 5(1.014 2~1.647 3) 0.381 乳酸 1.3155(1.154 6~1.498 8) < 0.001 LAR 190.656 7(9.010 0~4034.416 0) < 0.001 2 112.699 8(29.345 7~1 521.495 8) 0.000 5 D-D 1.000 1(1.000 1~1.000 3) 0.009 7 1.000 2(1.000 1~1.000 4) 0.030 2
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表 3 LAR与D-D评价IHCA后ROSC患者短期预后的评估价值
预测指标 AUC 截断值 灵敏度 特异度 LAR 0.724 0.272 0.694 0.786 D-D 0.706 2 665.5 0.661 0.738 联合指标 0.786 0.567 0.833 0.667
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