Han Didi, Zhang Luming, Zheng Shuai, Xu Fengshuo, Li Chengzhuo, Yang Rui, Ma Wen, Yin Haiyan, Lyu Jun
Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangdong Province 510630, China.
School of Public Health, Xi'an Jiaotong University Health Science Center, Shaanxi Province 710061, China.
Biomed Res Int. 2021 May 22;2021:5595042. doi: 10.1155/2021/5595042. eCollection 2021.
Research has previously been done into the risk factors for mortality in septic shock patients. However, there has been no epidemiological study investigating the effect of the blood urea nitrogen/creatinine ratio (BCR) on the prognosis of critically ill septic shock patients. This study is aimed at determining the relationship between BCR and all-cause mortality in adult septic shock patients.
Data were extracted from the MIMIC-III database. The clinical endpoints were 28-, 90-, and 365-day all-cause mortality rates in critically ill septic shock patients. Cox proportional hazards models and subgroup analyses were used to analyze the relationship between BCR quartiles and all-cause mortality in septic shock patients. Receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs) were calculated to evaluate how accurately BCR predicts the mortality of septic shock patients.
Among the 2484 septic shock patients extracted from the database, 619, 563, 677, and 625 fell into the first (<14.4 mg/dL), second (≥14.4 mg/dL and <20.0 mg/dL), third (≥20.0 mg/dL and <27.3 mg/dL), and fourth (≥27.3 mg/dL) quartiles of BCR, respectively. Male and white patients accounted for 53.8% (1336 patients) and 74.8% (1857 patients) of the population, respectively. The mean age of the population was 67.7 ± 15.8 years. An inverse M-shaped relationship between BCR and mortality in septic shock patients was identified, with a value of ≥27.3 mg/dL providing the highest risk (HR = 1.596, 95% CI: 1.396-1.824, < 0.001). In the Cox regression model adjusted for different confounding variables, BCR values in the fourth quartiles were significantly associated with increased mortality, using the first quartiles as a reference. The areas under the ROC curves (AUCs) for BCR plus the Sequential Organ Failure Assessment (SOFA) score and BCR plus Acute Physiology Score III (APSIII) were 0.694 (95% CI: 0.673-0.716) and 0.724 (95% CI: 0.703-0.744), respectively.
An inverse M-shaped curve was determined between BCR and the mortality of septic shock patients. BCR was identified as a readily available and independent prognostic biomarker for septic shock patients, and higher BCRs were associated with increased mortality in these patients.
此前已有研究探讨脓毒症休克患者的死亡风险因素。然而，尚无流行病学研究调查血尿素氮/肌酐比值（BCR）对重症脓毒症休克患者预后的影响。本研究旨在确定成年脓毒症休克患者BCR与全因死亡率之间的关系。
数据取自MIMIC-III数据库。临床终点为重症脓毒症休克患者28天、90天和365天的全因死亡率。采用Cox比例风险模型和亚组分析来分析脓毒症休克患者BCR四分位数与全因死亡率之间的关系。计算受试者工作特征（ROC）曲线及ROC曲线下面积（AUC），以评估BCR预测脓毒症休克患者死亡率的准确性。
从数据库中提取的2484例脓毒症休克患者中，619例、563例、677例和625例分别处于BCR的第一四分位数（<14.4mg/dL）、第二四分位数（≥14.4mg/dL且<20.0mg/dL）、第三四分位数（≥20.0mg/dL且<27.3mg/dL）和第四四分位数（≥27.3mg/dL）。男性和白人患者分别占总人群的53.8%（1336例患者）和74.8%（1857例患者）。人群的平均年龄为67.7±15.8岁。确定脓毒症休克患者BCR与死亡率之间呈倒M形关系，BCR值≥27.3mg/dL时风险最高（HR = 1.596，95%CI：1.396 - 1.824，P<0.001）。在针对不同混杂变量进行调整的Cox回归模型中，以第一四分位数为参照，第四四分位数的BCR值与死亡率增加显著相关。BCR加序贯器官衰竭评估（SOFA）评分以及BCR加急性生理学评分III（APSIII）的ROC曲线下面积（AUC）分别为0.694（95%CI：0.673 - 0.716）和0.724（95%CI：0.703 - 0.744）。
确定了脓毒症休克患者BCR与死亡率之间呈倒M形曲线。BCR被确定为脓毒症休克患者一种易于获得的独立预后生物标志物，较高的BCR与这些患者死亡率增加相关。
