Department of Nephrology, People's Hospital of Anji, Huzhou, China.
Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China.
Ren Fail. 2024 Dec;46(2):2374451. doi: 10.1080/0886022X.2024.2374451. Epub 2024 Jul 5.
The primary objective was to examine the association between the lactate/albumin ratio (LAR) and the prognosis of patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT).
Utilizing the Medical Information Mart for Intensive Care IV (MIMIC-IV, v2.0) database, we categorized 703 adult AKI patients undergoing CRRT into survival and non-survival groups based on 28-day mortality. Patients were further grouped by LAR tertiles: low (< 0.692), moderate (0.692-1.641), and high (> 1.641). Restricted cubic splines (RCS), Least Absolute Shrinkage and Selection Operator (LASSO) regression, inverse probability treatment weighting (IPTW), and Kaplan-Meier curves were employed.
In our study, the patients had a mortality rate of 50.07% within 28 days and 62.87% within 360 days. RCS analysis revealed a non-linear correlation between LAR and the risk of mortality at both 28 and 360 days. Cox regression analysis, which was adjusted for nine variables identified by LASSO, confirmed that a high LAR (>1.641) served as an independent predictor of mortality at these specific time points ( < 0.05) in AKI patients who were receiving CRRT. These findings remained consistent even after IPTW adjustment, thereby ensuring a reliable and robust outcome. Kaplan-Meier survival curves exhibited a gradual decline in cumulative survival rates at both 28 and 360 days as the LAR values increased (log-rank test, χ2 = 48.630, < 0.001; χ2 = 33.530, < 0.001).
A high LAR (>1.641) was found to be an autonomous predictor of mortality at both 28 and 360 days in critically ill patients with AKI undergoing CRRT.
本研究旨在探讨乳酸/白蛋白比值（LAR）与接受连续性肾脏替代治疗（CRRT）的急性肾损伤（AKI）患者预后之间的关系。
利用医疗信息互操作资源库 IV（MIMIC-IV，v2.0）数据库，我们根据 28 天死亡率将 703 例接受 CRRT 的成年 AKI 患者分为存活组和非存活组。根据 LAR 三分位数（低[<0.692]、中[0.692-1.641]和高[>1.641]）将患者进一步分组。采用限制性立方样条（RCS）、最小绝对值收缩和选择算子（LASSO）回归、逆概率处理加权（IPTW）和 Kaplan-Meier 曲线进行分析。
本研究中，患者在 28 天和 360 天的死亡率分别为 50.07%和 62.87%。RCS 分析显示，LAR 与 28 天和 360 天的死亡率之间存在非线性关系。经过 LASSO 确定的 9 个变量调整的 Cox 回归分析证实，高 LAR（>1.641）是 CRRT 治疗的 AKI 患者特定时间点死亡的独立预测因子（<0.05）。即使在 IPTW 调整后，这些发现仍然一致，从而确保了可靠和稳健的结果。Kaplan-Meier 生存曲线显示，随着 LAR 值的增加，28 天和 360 天的累积生存率逐渐下降（对数秩检验，χ2=48.630，<0.001；χ2=33.530，<0.001）。
高 LAR（>1.641）是 CRRT 治疗的危重症 AKI 患者 28 天和 360 天死亡率的独立预测因子。
