白蛋白-胆红素评分对心力衰竭患者住院死亡率预测的预后影响：一项回顾性队列研究。
Prognostic impact of albumin-bilirubin score on the prediction of in-hospital mortality in patients with heart failure: a retrospective cohort study.
机构信息
Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
出版信息
BMJ Open. 2022 Jan 4;12(1):e049325. doi: 10.1136/bmjopen-2021-049325.
OBJECTIVES
Liver dysfunction is prevalent in patients with heart failure (HF) and can lead to poor prognosis. The albumin-bilirubin (ALBI) score is considered as an effective and convenient scoring system for assessing liver function. We analysed the correlation between ALBI and in-hospital mortality in patients with HF.
DESIGN
A retrospective cohort study.
SETTING AND PARTICIPANTS
A total of 9749 patients with HF (from January 2013 to December 2018) was enrolled and retrospectively analysed.
MAIN OUTCOME MEASURES
The main outcome is in-hospital mortality.
RESULTS
ALBI score was calculated using the formula (log bilirubin [umol/L] * 0.66) + (albumin [g/L] * -0.085), and analysed as a continuous variable as well as according to three categories. Following adjustment for multivariate analysis, patients which occurred in-hospital death was remarkably elevated in tertile 3 group (ALBI ≥2.27) (OR 1.671, 95% CI 1.228 to 2.274, p=0.001), relative to the other two groups (tertile 1: ≤2.59; tertile 2: -2.59 to -2.27). Considering ALBI score as a continuous variable, the in-hospital mortality among patients with HF increased by 8.2% for every 0.1-point increase in ALBI score (OR 1.082; 95% CI 1.052 to 1.114; p<0.001). The ALBI score for predicting in-hospital mortality under C-statistic was 0.650 (95% CI 0.641 to 0.660, p<0.001) and the cut-off value of ALBI score was -2.32 with a specificity of 0.630 and a sensitivity of 0.632. Moreover, ALBI score can enhance the predictive potential of NT-pro-BNP (NT-pro-BNP +ALBI vs NT-pro-BNP: C-statistic: z=1.990, p=0.0467; net reclassification improvement=0.4012, p<0.001; integrated discrimination improvement=0.0082, p<0.001).
CONCLUSIONS
In patients with HF, the ALBI score was an independent prognosticator of in-hospital mortality. The predictive significance of NT-proBNP +ALBI score was superior to NT-proBNP, and ALBI score can enhance the predictive potential of NT-proBNP.
目的
肝功能障碍在心力衰竭（HF）患者中较为常见，可导致预后不良。白蛋白-胆红素（ALBI）评分被认为是评估肝功能的一种有效且便捷的评分系统。我们分析了 ALBI 与 HF 患者住院死亡率之间的相关性。
设计
回顾性队列研究。
地点和参与者
共纳入 9749 例 HF 患者（2013 年 1 月至 2018 年 12 月），并进行回顾性分析。
主要观察指标
主要观察指标为住院死亡率。
结果
ALBI 评分采用公式（log 胆红素[umol/L] * 0.66）+（白蛋白[g/L] * -0.085）计算，并作为连续变量和三个类别进行分析。经多变量分析调整后，第 3 组（ALBI≥2.27）发生院内死亡的患者显著增加（OR 1.671，95%CI 1.228 至 2.274，p=0.001），与其他两组（第 1 组：≤2.59；第 2 组：-2.59 至-2.27）相比。考虑到 ALBI 评分作为连续变量，HF 患者的 ALBI 评分每增加 0.1 分，其住院死亡率增加 8.2%（OR 1.082；95%CI 1.052 至 1.114；p<0.001）。C 统计量下 ALBI 评分预测住院死亡率的截断值为-2.32，特异性为 0.630，灵敏度为 0.632。此外，ALBI 评分可提高 NT-pro-BNP 的预测能力（NT-pro-BNP+ALBI 与 NT-pro-BNP：C 统计量：z=1.990，p=0.0467；净重新分类改善=0.4012，p<0.001；综合鉴别改善=0.0082，p<0.001）。
结论
在 HF 患者中，ALBI 评分是住院死亡率的独立预后指标。NT-proBNP+ALBI 评分的预测意义优于 NT-proBNP，ALBI 评分可提高 NT-proBNP 的预测能力。
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