尿白蛋白与肌酐比值与脓毒症患儿预后的关系
Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis.
作者信息
Sachdev Anil, Raheja Karan, Gupta Neeraj, Chugh Parul
机构信息
Pediatric Emergency, Critical Care and Pulmonology, Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India.
Pediatric Emergency and Critical Care, Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India.
出版信息
Indian J Crit Care Med. 2020 Jun;24(6):465-472. doi: 10.5005/jp-journals-10071-23463.
OBJECTIVE
The aim of the study was to investigate the association of urinary albumin:creatinine ratio (ACR) with regard to the outcome of sepsis patients and to study the trends of ACR with severity of disease, organ dysfunction, microcirculation status, the use of inotrope, and mechanical ventilation use, and length of pediatric intensive care unit (PICU) stay.
MATERIALS AND METHODS
In the prospective observational study, the patients with varying categories of sepsis admitted in the PICU with stay >24 hours were enrolled consecutively. Urine samples were collected at the time of admission (ACR1), 12 hours (ACR2), and 24 hours (ACR3).
RESULTS
One hundred and thirty-eight patients including 56 cases of sepsis, 31 of severe sepsis, 22 of septic shock, and 29 of multiorgan dysfunction syndrome (MODS) cases were analyzed. There were 29 (21%) deaths. ACR (median, IQR) was significantly higher in nonsurvivors [ACR1 198.9 (111.2-329.4) vs 124.5 (59.37-294.5), 0.03], [ACR2 213.8 (112.5-350) vs 117.8 (62.6-211.9) 0.008], [ACR3 231.8 (99.9-441.2 vs 114.4 (44.1-240.3), 0.005]. The ACR is increased progressively with the increasing severity of sepsis ( < 0.001). The performance of ACR operative characteristics was compared with that of PRISM and PELOD scores. In deceased, ACR was significantly correlated with blood pH, lactate, and base deficit. A cutoff value of ACR 102.7 mg/g had sensitivity 86.2%, specificity 40.4%, positive predictive value 27.8%, and negative predictive value 91.7%. The use of inotropes, mechanical ventilation (>48 hours), and mortality was significantly higher in patients with ACR >102 mg/g. The probability of death varied from 17.6 to 19% in the first 24 hours of admission. ACR was significantly cheaper as compared to PRISM score and PELOD score estimations.
CONCLUSION
Urinary ACR, a cost-effective tool, correlates with the severity of sepsis and associated morbidity and mortality in children.
HOW TO CITE THIS ARTICLE
Sachdev A, Raheja K, Gupta N, Chugh P. Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis. Indian J Crit Care Med 2020;24(6):465-472.
目的
本研究旨在探讨尿白蛋白与肌酐比值（ACR）与脓毒症患者预后的关系，并研究ACR随疾病严重程度、器官功能障碍、微循环状态、血管活性药物使用情况、机械通气使用情况以及儿科重症监护病房（PICU）住院时间的变化趋势。
材料与方法
在这项前瞻性观察性研究中，连续纳入入住PICU且住院时间>24小时的不同类型脓毒症患者。在入院时（ACR1）、12小时（ACR2）和24小时（ACR3）采集尿液样本。
结果
分析了138例患者，包括56例脓毒症、31例严重脓毒症、22例脓毒性休克和29例多器官功能障碍综合征（MODS）患者。有29例（21%）死亡。非幸存者的ACR（中位数，四分位间距）显著更高[ACR1 198.9（111.2 - 329.4）对比124.5（59.37 - 294.5），P = 0.03]，[ACR2 213.8（112.5 - 350）对比117.8（62.6 - 211.9），P = 0.008]，[ACR3 231.8（99.9 - 441.2）对比114.4（44.1 - 240.3），P = 0.005]。ACR随着脓毒症严重程度的增加而逐渐升高（P < 0.001）。将ACR的诊断性能与PRISM和PELOD评分进行了比较。在死亡患者中，ACR与血pH值、乳酸和碱缺失显著相关。ACR为102.7 mg/g时的截断值，敏感性为86.2%，特异性为40.4%，阳性预测值为27.8%，阴性预测值为91.7%。ACR>102 mg/g的患者使用血管活性药物、机械通气（>48小时）和死亡率显著更高。入院后前24小时内死亡概率在17.6%至19%之间。与PRISM评分和PELOD评分评估相比，ACR成本显著更低。
结论
尿ACR是一种经济有效的工具，与儿童脓毒症的严重程度及相关发病率和死亡率相关。
如何引用本文
Sachdev A, Raheja K, Gupta N, Chugh P. Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis. Indian J Crit Care Med 2020;24(6):465 - 472.
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