血尿素氮与白蛋白比值预测冠状动脉旁路移植术后患者的长期死亡率：MIMIC-III数据库分析
Blood Urea Nitrogen-to-Albumin Ratio in Predicting Long-Term Mortality in Patients Following Coronary Artery Bypass Grafting: An Analysis of the MIMIC-III Database.
作者信息
Zhao Diming, Chen Shanghao, Liu Yilin, Xu Zhenqiang, Shen Hechen, Zhang Shijie, Li Yi, Zhang Haizhou, Zou Chengwei, Ma Xiaochun
机构信息
Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Ophthalmology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China.
出版信息
Front Surg. 2022 Feb 18;9:801708. doi: 10.3389/fsurg.2022.801708. eCollection 2022.
BACKGROUND
This study examined the role of blood urea nitrogen-to-albumin ratio (BAR) in predicting long-term mortality in patients undergoing coronary artery bypass grafting (CABG).
METHODS
In this retrospective cohort study, patients undergoing CABG were enrolled from the Medical Information Mart for Intensive Care III (MIMIC III) database. Patients were divided into the three groups according to the optimal cutoff values of BAR determined by X-tile software. The survival curve was constructed by the Kaplan-Meier method and multivariate Cox regression analysis was performed to explore the independent prognostic factors of 1- and 4-year mortality after CABG. The receiver operating characteristic (ROC) curves and the areas under the ROC curves (AUCs) were calculated to estimate the accuracy of BAR in predicting the outcomes. Subgroup analyses were also carried out.
RESULTS
A total of 1,462 patients at 4-year follow-up were included, of which 933, 293, and 236 patients were categorized into the group 1 (≤ 6.45 mg/g), group 2 (>6.45 and ≤ 10.23 mg/g), and group 3 (>10.23 mg/g), respectively. Non-survivors showed an increased level of BAR at both 1- ( < 0.001) and 4-year ( < 0.001) follow-up compared with the survivors. The patients with a higher BAR had a higher risk of 1- and 4-year mortality following CABG (33.05 vs. 14.33 vs. 5.14%, < 0.001 and 52.97 vs. 30.72 vs. 13.08%, < 0.001, respectively). Cox proportional hazards regression model suggested a higher BAR as an independent risk factor of 1-year mortality (HR 3.904; 95% CI 2.559-5.956; < 0.001) and 4-year mortality (HR 2.895; 95% CI 2.138-3.921; < 0.001) after adjusting for confounders. Besides, the receiver operating characteristic (ROC) curves showed the better predictive ability of BAR compared to other grading scores at both 1- (0.7383, 95% CI: 0.6966-0.7800) and 4-year mortality (0.7189, 95% CI: 0.6872-0.7506). Subgroup analysis demonstrated no heterogeneous results of BAR in 4-year mortality in particular groups of patient.
CONCLUSION
This report provided evidence of an independent association between 1- and 4-year mortality after CABG and BAR. A higher BAR was associated with a higher risk of long-term mortality and could serve as a prognostic predictor in patients following CABG.
背景
本研究探讨了血尿素氮与白蛋白比值（BAR）在预测冠状动脉旁路移植术（CABG）患者长期死亡率中的作用。
方法
在这项回顾性队列研究中，从重症监护医学信息数据库III（MIMIC III）中纳入接受CABG的患者。根据X-tile软件确定的BAR最佳截断值将患者分为三组。采用Kaplan-Meier法构建生存曲线，并进行多因素Cox回归分析，以探讨CABG术后1年和4年死亡率的独立预后因素。计算受试者工作特征（ROC）曲线及ROC曲线下面积（AUC），以评估BAR预测预后的准确性。同时进行亚组分析。
结果
共纳入1462例患者进行4年随访，其中933例、293例和236例患者分别被归入第1组（≤6.45mg/g）、第2组（>6.45且≤10.23mg/g）和第3组（>10.23mg/g）。与幸存者相比，非幸存者在1年（<0.001）和4年（<0.001）随访时的BAR水平均升高。BAR较高的患者CABG术后1年和4年死亡风险更高（分别为33.05%对14.33%对5.14%，<0.001；52.97%对30.72%对13.08%，<0.001）。Cox比例风险回归模型表明，校正混杂因素后，较高的BAR是1年死亡率（HR 3.904；95%CI 2.559-5.956；<。001）和4年死亡率（HR 2.895；95%CI 2.138-3.921；<0.001）的独立危险因素。此外，ROC曲线显示，与其他分级评分相比，BAR在预测1年（0.7383，95%CI：0.6966-0.7800）和4年死亡率（0.7189，95%CI：0.6872-0.7506）方面具有更好的预测能力。亚组分析表明，BAR在特定患者组的4年死亡率方面没有异质性结果。
结论
本报告提供了证据，证明CABG术后1年和4年死亡率与BAR之间存在独立关联。较高的BAR与较高的长期死亡风险相关，可作为CABG术后患者的预后预测指标。
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