Jin Bo-Yeong, Lee Sukyo, Kim Woosik, Park Jong-Hak, Cho Hanjin, Moon Sungwoo, Ahn Sejoong
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea.
Biomedicines. 2024 Jun 26;12(7):1421. doi: 10.3390/biomedicines12071421.
Ischemia-modified albumin (IMA) is produced during ischemia and reactive oxygen species production. This study aimed to evaluate the association between IMA and mortality in a larger population and the prognostic value of the combination of IMA and lactate for predicting mortality in septic shock patients in the emergency department. This retrospective observational study included adult septic shock patients between October 2019 and December 2021. A multivariable Cox proportional hazards model was performed. IMA was significantly higher in the non-surviving group than in the surviving group (89.1 ± 7.2 vs. 83.8 ± 6.2 U/mL, < 0.001). IMA was independently associated with 28-day mortality after adjustments (adjusted hazard ratio [aHR]: 1.075, 95% confidence interval [CI]: 1.016-1.138, = 0.012). The area under the ROC curve (AUROC) of IMA was 0.712 (95% CI: 0.648-0.775, < 0.001) and was comparable to that of lactate. The AUROC of the combination of IMA and lactate was 0.838 (95% CI: 0.786-0.889, < 0.001). The group with both high lactate and high IMA levels showed an extremely high risk of mortality than other groups (86.1%; aHR 8.956, 95% CI 4.071-19.70, < 0.001). The elevation of IMA was associated with mortality in septic shock patients. The combination of IMA and lactate can be a helpful tool for early risk stratification of septic shock patients.
缺血修饰白蛋白（IMA）在缺血和活性氧生成过程中产生。本研究旨在评估在更大规模人群中IMA与死亡率之间的关联，以及IMA与乳酸联合用于预测急诊科感染性休克患者死亡率的预后价值。这项回顾性观察性研究纳入了2019年10月至2021年12月期间的成年感染性休克患者。进行了多变量Cox比例风险模型分析。非存活组的IMA显著高于存活组（89.1±7.2 vs. 83.8±6.2 U/mL，P<0.001）。调整后IMA与28天死亡率独立相关（调整后风险比[aHR]：1.075，95%置信区间[CI]：1.016 - 1.138，P = 0.012）。IMA的ROC曲线下面积（AUROC）为0.712（95% CI：0.648 - 0.775，P<0.001），与乳酸的相当。IMA与乳酸联合的AUROC为0.838（95% CI：0.786 - 0.889，P<0.001）。乳酸和IMA水平均高的组比其他组显示出极高的死亡风险（86.1%；aHR 8.956，95% CI 4.071 - 19.70，P<0.001）。IMA升高与感染性休克患者的死亡率相关。IMA与乳酸联合可为感染性休克患者的早期风险分层提供有用工具。
