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血清白蛋白水平对入住重症监护病房后 24 小时内去甲肾上腺素和液体需求的预测价值——一项前瞻性观察研究。

Predictive value of serum albumin levels on noradrenaline and fluid requirements in the first 24 h after admission to the Intensive Care Unit - A prospective observational study.

机构信息

Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Intensive Care, Maxima Medical Center, Veldhoven, The Netherlands.

Department of Intensive Care, Maxima Medical Center, Veldhoven, The Netherlands.

出版信息

J Crit Care. 2018 Oct;47:99-103. doi: 10.1016/j.jcrc.2018.06.011. Epub 2018 Jun 8.

Abstract

PURPOSE

To determine the predictive value of serum albumin (SA) at admission to the intensive care unit (ICU) on the cumulative dose of noradrenaline, the fluids administered, the lactate level, and mortality during the first 24 h of ICU admission.

METHODS

A total of 100 ICU patients were included. The association between SA and the cumulative dose of noradrenaline was analyzed using logistic regression. For the total amount of fluids administered linear regression, for the lactate level and for 24 h mortality logistic regression was used. Age, gender, patient category, type of surgery, severe sepsis, lactate level, estimated glomerular filtration rate, c-reactive protein level, and the target mean arterial pressure were considered effect modifiers.

RESULTS

SA was significantly associated with the dose of noradrenaline (OR 0.92, 95% CI 0.84–0.99, p = 0.028), lower lactate levels (OR 1.14, 95% CI 1.00–1.30, p = 0.049), and with the amount of fluids administered (B -0.02, 95% CI −0.03/−0.00, p = 0.016), but not with mortality (OR 0.95, 95% CI 0.85–1.07, p = 0.41).

CONCLUSIONS

SA significantly predicts noradrenaline and fluid requirements as well as the change in lactate level during the first 24 h of ICU admission. Our observations have to be validated in another large cohort.

摘要

目的

确定入院时血清白蛋白(SA)对重症监护病房(ICU)入组 24 小时内去甲肾上腺素累积剂量、输注液体量、乳酸水平和死亡率的预测价值。

方法

共纳入 100 例 ICU 患者。使用逻辑回归分析 SA 与去甲肾上腺素累积剂量之间的关系。对于输注液体总量,使用线性回归,对于乳酸水平和 24 小时死亡率,使用逻辑回归。年龄、性别、患者类别、手术类型、严重脓毒症、乳酸水平、估计肾小球滤过率、C 反应蛋白水平和目标平均动脉压被认为是效应修饰剂。

结果

SA 与去甲肾上腺素剂量(OR 0.92,95%CI 0.84–0.99,p = 0.028)、较低的乳酸水平(OR 1.14,95%CI 1.00–1.30,p = 0.049)和输注液体量(B -0.02,95%CI -0.03/−0.00,p = 0.016)显著相关,但与死亡率无关(OR 0.95,95%CI 0.85–1.07,p = 0.41)。

结论

SA 显著预测 ICU 入组 24 小时内去甲肾上腺素和液体需求以及乳酸水平的变化。我们的观察结果需要在另一个大队列中得到验证。

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