血清肌酐/胱抑素 C 比值可预测慢性阻塞性肺疾病急性加重住院患者的院内死亡率。
Serum Creatinine/Cystatin C Ratio as a Predictor of In-hospital Mortality in Patients Hospitalized with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.
机构信息
Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, No. 430, Jiuhua South Road, Wuhu, Anhui, China.
Department of Emergency and Critical Care, Conch Hospital of Anhui Medical University, No. 327, Jiuhua South Road, Wuhu, Anhui, China.
出版信息
Lung. 2022 Oct;200(5):609-617. doi: 10.1007/s00408-022-00568-5. Epub 2022 Sep 15.
PURPOSE
Low serum creatinine/cystatin C ratio (CCR) is associated with unfavorable characteristics in patients with chronic obstructive pulmonary disease (COPD); however, the relationship between CCR and in-hospital mortality of patients with acute exacerbation of COPD (AECOPD) is unexplored. Our objective was to assess the value of CCR for predicting in-hospital mortality of patients hospitalized with AECOPD.
METHODS
Patients with AECOPD (n = 597) were retrospectively enrolled. Patient's clinical characteristics and laboratory tests, including serum cystatin C and creatinine, were reviewed. The prediction value of CCR was evaluated using area under the receiver operating characteristic curve (AUC) values. Factors potentially impacting in-hospital mortality were investigated using univariate and multivariate logistic regression analyses.
RESULTS
Mortality rate during hospitalization was 10.05%. CCR was lower in non-surviving vs. survived patients (41.67 vs. 61.52, P < 0.001). AUC value for CCR for in-hospital mortality prediction was 0.79 [95% confidence interval (CI) 0.73-0.85]. On multivariate logistic regression analysis, in-hospital mortality was strongly associated with CCR < 52.27 [odds ratio (OR) 6.23, 95% CI (3.00-12.92), P < 0.001], age ≥ 81 years [OR 2.97, 95% CI (1.20-7.37), P = 0.019], oxygenation index < 300 [OR 3.28, 95% CI (1.27-8.44), P = 0.014], CRP > 8 mg/L [OR 1.84, 95% CI (1.15-2.95), P = 0.012], and D-dimer > 500 ng/L [OR 5.19, 95% CI (1.51-17.79), P = 0.009].
CONCLUSIONS
CCR was significantly lower, and is a potential prognostic indicator, in patients with AECOPD who died during hospitalization.
目的
低血清肌酐/胱抑素 C 比值（CCR）与慢性阻塞性肺疾病（COPD）患者的不良特征相关；然而，CCR 与 COPD 急性加重（AECOPD）患者住院期间死亡率的关系尚未得到探索。我们的目的是评估 CCR 对预测 AECOPD 住院患者住院期间死亡率的价值。
方法
回顾性纳入 AECOPD 患者（n=597）。回顾患者的临床特征和实验室检查，包括血清胱抑素 C 和肌酐。使用接受者操作特征曲线（ROC）下面积（AUC）值评估 CCR 的预测价值。使用单因素和多因素逻辑回归分析调查可能影响住院死亡率的因素。
结果
住院期间死亡率为 10.05%。与存活患者相比，死亡患者的 CCR 更低（41.67 与 61.52，P<0.001）。CCR 对住院死亡率预测的 AUC 值为 0.79[95%置信区间（CI）0.73-0.85]。在多因素逻辑回归分析中，住院死亡率与 CCR<52.27[比值比（OR）6.23，95%CI（3.00-12.92）]强烈相关，P<0.001]、年龄≥81 岁[OR 2.97，95%CI（1.20-7.37）]，P=0.019]、氧合指数<300[OR 3.28，95%CI（1.27-8.44）]，P=0.014]、C 反应蛋白（CRP）>8mg/L[OR 1.84，95%CI（1.15-2.95）]，P=0.012]和 D-二聚体>500ng/L[OR 5.19，95%CI（1.51-17.79）]，P=0.009]。
结论
在住院期间死亡的 AECOPD 患者中，CCR 明显降低，是潜在的预后指标。
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