低白蛋白血症对肝硬化自发性细菌性腹膜炎患者死亡率的影响。
Effect of hypoalbuminemia on mortality in cirrhotic patients with spontaneous bacterial peritonitis.
作者信息
Hung Tsung-Hsing, Ko Ping-Hung, Wang Chih-Ying, Tsai Chih-Chun, Lee Hsing-Feng
机构信息
Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
出版信息
Tzu Chi Med J. 2023 Dec 13;36(1):92-97. doi: 10.4103/tcmj.tcmj_211_23. eCollection 2024 Jan-Mar.
OBJECTIVES
The impact of hypoalbuminemia on the short-term and long-term mortality of cirrhotic patients with spontaneous bacterial peritonitis (SBP), both with and without renal function impairment, remains insufficiently elucidated based on population-based data.
MATERIALS AND METHODS
We retrieved data from Taiwan's National Health Insurance Database encompassing 14,583 hospitalized patients diagnosed with both cirrhosis and SBP during the period from January 1, 2010, to December 31, 2013. Prognostic factors influencing 30-day and 3-year survival were computed. Furthermore, the impact of hypoalbuminemia on the mortality rate among SBP patients, with or without concurrent renal function impairment, was also assessed.
RESULTS
The 30-day mortality rates for patients with SBP, comparing those with hypoalbuminemia and those without, were 18.3% and 29.4%, respectively ( < 0.001). Similarly, the 3-year mortality rates for SBP patients with hypoalbuminemia and those without were 73.7% and 85.8%, respectively ( < 0.001). Cox proportional hazard regression analysis, adjusted for patients' gender, age, and comorbid conditions, substantiated that individuals with hypoalbuminemia exhibit an inferior 30-day survival (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.51-1.74, < 0.001) and reduced 3-year survival (HR: 1.57, 95% CI: 1.50-1.63, < 0.001) in comparison to those lacking hypoalbuminemia. Among SBP patients with renal function impairment, those presenting hypoalbuminemia also experienced diminished 30-day survival (HR: 1.81, 95% CI 1.57-2.07, < 0.001) as well as reduced 3-year survival (HR: 1.70, 95% CI 1.54-1.87, < 0.001). Likewise, in SBP patients without renal function impairment, the presence of hypoalbuminemia was associated with poorer 30-day survival (HR: 1.54, 95% CI 1.42-1.67, < 0.001) and 3-year survival (HR: 1.53, 95% CI 1.46-1.60, < 0.001).
CONCLUSION
Among cirrhotic patients with SBP, the presence of hypoalbuminemia predicts inferior short-term and long-term outcomes, regardless of renal function.
目的
基于人群数据，低白蛋白血症对伴有或不伴有肾功能损害的肝硬化自发性细菌性腹膜炎（SBP）患者短期和长期死亡率的影响仍未得到充分阐明。
材料与方法
我们从台湾国民健康保险数据库中检索了2010年1月1日至2013年12月31日期间14583例被诊断为肝硬化和SBP的住院患者的数据。计算影响30天和3年生存率的预后因素。此外，还评估了低白蛋白血症对伴有或不伴有并发肾功能损害的SBP患者死亡率的影响。
结果
SBP患者中，低白蛋白血症患者和非低白蛋白血症患者的30天死亡率分别为18.3%和29.4%（<0.001）。同样，低白蛋白血症和非低白蛋白血症的SBP患者3年死亡率分别为73.7%和85.8%（<0.001）。经患者性别、年龄和合并症校正的Cox比例风险回归分析证实，与无低白蛋白血症的患者相比，低白蛋白血症患者的30天生存率较低（风险比[HR]：1.62，95%置信区间[CI]：1.51 - 1.74，<0.001），3年生存率降低（HR：1.57，95%CI：1.50 - 1.63，<0.001）。在伴有肾功能损害的SBP患者中，出现低白蛋白血症的患者30天生存率也降低（HR：1.81，95%CI 1.57 - 2.07，<0.001），3年生存率降低（HR：1.70，95%CI 1.54 - 1.87，<0.001）。同样，在无肾功能损害的SBP患者中，低白蛋白血症与较差的30天生存率（HR：1.54，95%CI 1.42 - 1.67，<0.001）和3年生存率（HR：1.53，95%CI 1.46 - 1.60，<0.001）相关。
结论
在肝硬化SBP患者中，无论肾功能如何，低白蛋白血症的存在预示着短期和长期预后较差。
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