Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital, Huzhou University, Huzhou, 313000, Zhejiang Province, China.
Department of General Practice, Huzhou Central Hospital, Affiliated Central Hospital, Huzhou University, No.1558, North Sanhuan Road, Huzhou, 313000, Zhejiang Province, China.
BMC Anesthesiol. 2022 Dec 28;22(1):404. doi: 10.1186/s12871-022-01947-4.
Sepsis is a common critical illness in intensive care unit (ICU) and seriously threatens the life of patients. Therefore, to identify a simple and effective clinical indicator to determine prognosis is essential for the management of sepsis patients. This study was mainly based on blood urea nitrogen to albumin ratio (B/A), a comprehensive index, to explore its correlation with the prognosis of sepsis patients during hospitalization.
Totally, adult patients in ICU who were diagnosed with sepsis in Medical Information Mart for Intensive Care IV(MIMIC-IV) database from 2008 to 2019 were involved in this study. The study population were divided into survivors group and non-survivors group based on the prognosis during hospitalization. Restricted cubic spline (RCS) was utilized to analyze the association between B/A level and the risk of ICU all-cause mortality in patients with sepsis and determine the optimal cut-off value of B/A. The study population was divided into low B/A group and high B/A group based on the optimal cut-off value. The survival curve of ICU cumulative survival rate was draw through Kaplan-Meier method. The correlation between B/A and the prognosis of patients was conducted by multivariate Cox regression analysis. Furthermore, we performed sensitivity analyses to assess the robustness of the results.
A total of 10,578 patients with sepsis were enrolled, and the ICU all-cause mortality was 15.89%. The patients in the non-survivors group had higher B/A values and more comorbidities than those in the survivors group. RCS showed that the risk of ICU all-cause mortality increased with the B/A level, showing a non-linear trend (χ2 = 66.82, p < 0.001). The mortality rate in the high B/A group was significantly higher than that in the low B/A group (p < 0.001). Kaplan-Meier curves revealed that compared with the low B/A group, the ICU cumulative survival rate of patients with sepsis was significantly lower in the high B/A group (log-rank test, χ2 = 148.620, p < 0.001). Further analysis of multivariate Cox proportional hazards regression showed that an elevated B/A (≥ 7.93) was an independent factor associated with ICU mortality among patients with sepsis.
An elevated B/A might be a useful prognostic indicator in patients with sepsis. This study could offer a deeper insight into treating sepsis.
脓毒症是重症监护病房（ICU）中常见的危重病，严重威胁患者的生命。因此，确定一个简单有效的临床指标来判断预后对于脓毒症患者的治疗至关重要。本研究主要基于血尿素氮与白蛋白比值（B/A）这一综合指标，探讨其与脓毒症患者住院期间预后的相关性。
本研究纳入了 2008 年至 2019 年在医疗信息存储与计算机检索系统 IV（MIMIC-IV）数据库中被诊断为脓毒症的 ICU 成年患者。根据住院期间的预后，将研究人群分为存活组和非存活组。采用受限立方样条（RCS）分析 B/A 水平与脓毒症患者 ICU 全因死亡率的相关性，并确定 B/A 的最佳截断值。根据最佳截断值，将研究人群分为低 B/A 组和高 B/A 组。通过 Kaplan-Meier 法绘制 ICU 累积生存率的生存曲线。采用多变量 Cox 回归分析 B/A 与患者预后的相关性。此外，还进行了敏感性分析以评估结果的稳健性。
共纳入 10578 例脓毒症患者，ICU 全因死亡率为 15.89%。非存活组患者的 B/A 值更高，合并症更多。RCS 显示，ICU 全因死亡率随 B/A 水平的升高而增加，呈非线性趋势（χ2=66.82，p<0.001）。高 B/A 组的死亡率明显高于低 B/A 组（p<0.001）。Kaplan-Meier 曲线显示，与低 B/A 组相比，高 B/A 组的脓毒症患者 ICU 累积生存率明显较低（对数秩检验，χ2=148.620，p<0.001）。多变量 Cox 比例风险回归分析进一步表明，升高的 B/A（≥7.93）是脓毒症患者 ICU 死亡率的独立相关因素。
升高的 B/A 可能是脓毒症患者的有用预后指标。本研究为脓毒症的治疗提供了更深入的认识。
