乳酸/白蛋白比值对重症非ST段抬高型心肌梗死患者预后的预测价值OA
Predictive value of lactate-to-albumin ratio on prognosis in critically ill patients with non-ST-segment elevation myocardial infarction
目的 探讨乳酸/白蛋白比值(LAR)对重症非ST段抬高型心肌梗死(NSTEMI)患者预后的预测价值.方法 回顾性分析重症监护医学信息数据库(MIMIC-Ⅳ,v2.0)NSTEMI患者443例.依据30 d预后,将患者分为存活组(317例)和死亡组(126例),比较两组一般情况.采用限制性立方样条(RCS)来获取LAR分组的截断值,将LAR患者分为低LAR组和高LAR组.绘制Kaplan-Meier生存曲线,比较两组30 d及90 d累积生存率.Cox比例风险回归模型用于分析LAR与患者30 d死亡的关系,并采用受试者工作特征(ROC)曲线来分析LAR对患者30 d死亡的预测价值.结果 LAR在死亡组更高(Z=-6.978,P<0.05).RCS分析显示,LAR与重症NSTEMI患者30 d全因死亡风险整体呈非线性趋势关系(χ2=28.650,P<0.01).当 30 d全因死亡HR为1时,LAR为0.625,根据此值,将患者分为低LAR组(<0.625)224例和高LAR组(≥0.625)219 例.Kaplan-Meier生存曲线显示,与低LAR组比较,高LAR组 30 d及 90 d的累积生存率更低(χ2=41.444,P<0.01;χ2=36.327,P<0.01).多因素Cox分析显示,高LAR是重症NSTEMI患者30 d全因死亡的危险因素(P<0.05).ROC曲线得出LAR预测重症NSTEMI患者30 d死亡的曲线下面积分别为 0.712,敏感度为 0.667,特异度为 0.688.结论 入ICU时高LAR是重症NSTEMI患者30 d全因死亡的危险因素,可用于预测重症NSTEMI患者30 d预后.
Objective To investigate the predictive value of the lactate-to-albumin ratio(LAR)on the prognosis of critically ill patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods A retrospective analysis was conducted on 443 patients with NSTEMI from the Medical Information Mart for Intensive CareⅣ(MIMIC-Ⅳ,v2.0).Patients were divided into survival(317 cases)and non-survival(126 cases)groups based on 30-day outcomes,and their general characteristics were compared.Restricted cubic splines(RCS)were used to obtain the cutoff values of LAR grouping.LAR patients were divided into the low LAR group and the high LAR group.Kaplan-Meier survival curves were plotted to compare the cumulative survival rates at 30 and 90 days between the two groups.Cox proportional hazards regression models were used to analyze the association between LAR and 30-day mortality.Receiver operating characteristic(ROC)curves were used to assess the predictive value of LAR for 30-day mortality.Results LAR was significantly higher in the non-survival group(Z=-6.978,P<0.05).RCS analysis showed a nonlinear relationship between LAR and the risk of 30-day all-cause mortality in critically ill NSTEMI patients(χ2=28.650,P<0.01).When the HR for 30-day all-cause mortality was 1,the corresponding LAR value was 0.625.Accordingly,patients were stratified into a low LAR group(<0.625,224 cases)and a high LAR group(≥0.625,219 cases).Kaplan-Meier survival curves showed that the high LAR group had lower cumulative survival rates at both 30 and 90 days compared to the low LAR group(χ2=41.444,P<0.01;χ2=36.327,P<0.01).Multivariate Cox analysis revealed that high LAR was a risk factor for 30-day all-cause mortality in critically ill NSTEMI patients(P<0.05).ROC curve analysis yielded an area under the curve(AUC)of 0.712 for LAR in predicting 30-day mortality in critically ill NSTEMI patients,with a sensitivity of 0.667 and a specificity of 0.688.Conclusion Elevated LAR at ICU admission is a risk factor for 30-day all-cause mortality in critically ill NSTEMI patients and can be used to predict 30-day prognosis.
王红梅;顾秀明;范淑尧;廖骏;于翔
313000 湖州市第一人民医院,湖州师范学院附属第一医院心血管内科313000 湖州市第一人民医院,湖州师范学院附属第一医院心血管内科313000 湖州市第一人民医院,湖州师范学院附属第一医院心血管内科313000 湖州市第一人民医院,湖州师范学院附属第一医院心血管内科313000 浙江省湖州市中心医院临床医药试验中心
乳酸/白蛋白比值非ST段抬高型心肌梗死预测价值
Lactate-to-albumin ratioNon-ST-segment elevation myocardial infarctionPredictive value
《心脑血管病防治》 2026 (2)
11-15,5
浙江省教育厅一般科研项目(Y202353809)
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