Obialo C I, Okonofua E C, Nzerue M C, Tayade A S, Riley L J
Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia 30310, USA.
Kidney Int. 1999 Sep;56(3):1058-63. doi: 10.1046/j.1523-1755.1999.00622.x.
Role of hypoalbuminemia and hypocholesterolemia as co-predictors of mortality in acute renal failure.
Hypoalbuminemia (LA) and hypocholesterolemia (LC) have been reported to portend high mortality in both older patients and in patients with end-stage renal disease. Even though low levels have been reported in critically ill patients, they have not been clearly defined as predictors of mortality in acute renal failure (ARF). The impact of LA and LC on mortality in ARF is evaluated in this study.
We conducted a computer-assisted three-year retrospective review of all cases of de novo ARF seen at an inner city tertiary-care facility. One hundred cases met the criteria for inclusion in the study. We employed both univariate and multivariate logistic regression models to estimate the relative risks (RR) and 95% confidence intervals (CI) of mortality associated with several variables.
Predictors associated with a high risk of death identified in this study include LC < or = 150 mg/dl (< or = 3.9 mmol/liter; RR, 7.4; CI, 2.7 to 20.3), LA < or =35 g/liter (RR, 5.0; CI, 1.9 to 13.2), sepsis (RR, 9.4; CI, 3.7 to 23.9), mechanical ventilation (RR, 10.8; CI, 2.8 to 41.0), oliguria (RR 17.0; CI, 6.2 to 46.6), and multisystem organ failure (RR 24.7; CI, 10.3 to 59.1). The overall gross mortality was 39%, but mortality among intensive care unit patients was 82%. Survival was 82% among patients with serum albumin >35 g/liter versus 48% among those with serum albumin < or =35 g/liter (chi2 = 11.9, P = 0.0006). Similarly, survival was higher among patients with cholesterol >150 mg/dl (>3.9 mmol/liter) than those whose levels were < or =150 mg/dl (< or =3.9 mmol/liter; 85 vs. 44%, ch 17.3, P<0.0001). Significant association between LA and LC was observed (R = 0.4, P<0.0001). Age, gender, level of plasma creatinine, and underlying chronic medical conditions were not predictive of mortality.
Survival in ARF is significantly altered by the levels of albumin and cholesterol. Because both LC and LA can be cytokine mediated, their presence in ARF should be considered ominous.
低白蛋白血症和低胆固醇血症作为急性肾衰竭死亡率的共同预测指标的作用
据报道，低白蛋白血症（LA）和低胆固醇血症（LC）在老年患者和终末期肾病患者中预示着高死亡率。尽管在危重病患者中已报告有低水平情况，但它们尚未被明确界定为急性肾衰竭（ARF）死亡率的预测指标。本研究评估了LA和LC对ARF死亡率的影响。
我们对一家市中心三级医疗设施中所有新发ARF病例进行了为期三年的计算机辅助回顾性研究。100例病例符合纳入本研究的标准。我们采用单变量和多变量逻辑回归模型来估计与几个变量相关的死亡率的相对风险（RR）和95%置信区间（CI）。
本研究中确定的与高死亡风险相关的预测指标包括LC≤150mg/dl（≤3.9mmol/L；RR，7.4；CI，2.7至20.3），LA≤35g/L（RR，5.0；CI，1.9至13.2），脓毒症（RR，9.4；CI，3.7至23.9），机械通气（RR，10.8；CI，2.8至41.0），少尿（RR 17.0；CI，6.2至46.6），以及多系统器官衰竭（RR 24.7；CI，10.3至59.1）。总体总死亡率为39%，但重症监护病房患者的死亡率为82%。血清白蛋白>35g/L的患者生存率为82%，而血清白蛋白≤35g/L的患者生存率为48%（χ2 = 11.9，P = 0.0006）。同样，胆固醇>150mg/dl（>3.9mmol/L）的患者生存率高于胆固醇水平≤150mg/dl（≤3.9mmol/L）的患者（85%对44%，χ2 = 日，P<0.0001）。观察到LA和LC之间存在显著关联（R = 0.4，P<0.0001）。年龄、性别、血浆肌酐水平和潜在的慢性疾病状况不能预测死亡率。
ARF患者的生存率因白蛋白和胆固醇水平而显著改变。由于LC和LA都可能由细胞因子介导，它们在ARF中的存在应被视为不祥之兆。
