白蛋白校正阴离子间隙对ICU重度烧伤患者预后的预测价值OA

Objective To investigate the predictive value of albumin-corrected anion gap(ACAG)in predicting outcomes of patients with severe burns in the intensive care unit(ICU).Methods This single-center retrospective cohort study included 71 patients with severe burns admitted to the ICU of Daqing Oilfield General Hospital from July 2011 to July 2024.The patients were divided into a survival group(47 cases)and a death group(24 cases)based on their mortality status in the ICU.Clinical data within 24 hours of admission were collected,including demographic characteristics,disease severity scores,laboratory indicators,and ACAG values.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive efficacy of ACAG for mortality in ICU patients with severe burns.The optimal cut-off value of ACAG was determined based on the Youden index,and patients were divided into low-ACAG and high-ACAG groups accordingly.Kaplan-Meier survival curves were plotted to compare ICU survival rates between the high-ACAG and low-ACAG groups.Multivariate Cox regression analysis was performed to identify factors influencing mortality of ICU patients with severe burns.Restricted cubic spline(RCS)analysis was used to examine the independent association between ACAG and mortality of ICU patients with severe burns.Results Compared with the survivor group,the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,anion gap(AG),and ACAG in the death group were significantly higher(all P＜0.05).ROC curve analysis showed that ACAG had a higher area under the curve(AUC)for predicting mortality of ICU patients with severe burns than AG,APACHE Ⅱ score,and SOFA score(0.858 vs.0.753,0.791,and 0.804,respectively;all P＜0.01).The optimal cut-off value for ACAG was 16.99 mmol/L,with a sensitivity of 0.857 and a specificity of 0.796.Kaplan-Meier survival curve analysis indicated that the cumulative survival rate in the high-ACAG group was 53.3％,which was significantly lower than that in the low-ACAG group(78.0％,P＜0.01).Multivariate Cox regression analysis revealed that high ACAG level was an independent risk factor for mortality of ICU patients with severe burns(P＜0.01).RCS analysis demonstrated an independent and continuous positive association between ACAG and ICU mortality(HR=1.181,95％CI:1.102-1.273,P＜0.001).Conclusion ACAG is an independent predictor of prognosis in the ICU patients with severe burns,with superior predictive performance compared with traditional scoring systems.It may serve as an important tool for assessing mortality risk in patients.