Oh Ah Ran, Ryu Jeong-Am, Lee Seung Joo, Kim Chung Su, Lee Sangmin Maria
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Diagnostics (Basel). 2024 Aug 6;14(16):1709. doi: 10.3390/diagnostics14161709.
We compared the prognostic value of the C-reactive protein (CRP)-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and modified Glasgow prognostic score (mGPS) with the Sequential Organ Failure Assessment (SOFA) score in an intensive care unit (ICUs).
This study used the data of 53,877 adult patients admitted to an ICU between June 2013 and May 2022. Using the CAR, NLR, and mGPS values, as well as the SOFA score from the ICU, we conducted multivariable logistic regression analysis and used the receiver operating characteristic (ROC) curve to compare the predictive value for 28-day and 1-year mortality.
A total of 2419 patients (4.5%) died within 28 days, and 6209 (11.5%) patients died within 1 year. After an adjustment, all predictors were found to be independent risk factors for 28-day mortality (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.29-1.33, < 0.001 for the SOFA score; OR 1.05, 95% CI 1.03-1.07, < 0.001 for CAR; OR 1.01, 95% CI 1.00-1.02, < 0.001 for the NLR; and OR 1.19, 95% CI 1.08-1.30, < 0.001 for the mGPS). This trend persisted for the 1-year mortality. In ROC curve analysis, the CAR showed better predictability than the NLR and mGPS. Furthermore, the predictive power of the CAR was significantly higher than that of the SOFA score for 1-year mortality.
The CAR, NLR, and mGPS values at ICU admission were independent risk factors of mortality after ICU admission. The predictive value of CAR was higher than that of the SOFA score for 1-year mortality. CAR assessment at ICU admission may be a feasible predictor of long-term mortality.
我们在重症监护病房（ICU）中比较了C反应蛋白（CRP）与白蛋白比值（CAR）、中性粒细胞与淋巴细胞比值（NLR）、改良格拉斯哥预后评分（mGPS）与序贯器官衰竭评估（SOFA）评分的预后价值。
本研究使用了2013年6月至2022年5月期间入住ICU的53877例成年患者的数据。利用CAR、NLR和mGPS值以及ICU的SOFA评分，我们进行了多变量逻辑回归分析，并使用受试者工作特征（ROC）曲线比较了对28天和1年死亡率的预测价值。
共有2419例患者（4.5%）在28天内死亡，6209例患者（11.5%）在1年内死亡。调整后，所有预测指标均被发现是28天死亡率的独立危险因素（SOFA评分的比值比[OR]为1.31，95%置信区间[CI]为1.29 - 1.33，P < 0.001；CAR的OR为1.05，95% CI为1.03 - 1.07，P < 0.001；NLR的OR为1.01，95% CI为1.00 - 1.02，P < 0.001；mGPS的OR为1.19，95% CI为1.08 - 1.30，P < 0.001）。这种趋势在1年死亡率中持续存在。在ROC曲线分析中，CAR显示出比NLR和mGPS更好的预测性。此外，对于1年死亡率，CAR的预测能力显著高于SOFA评分。
ICU入院时的CAR、NLR和mGPS值是ICU入院后死亡率的独立危险因素。对于1年死亡率，CAR的预测价值高于SOFA评分。ICU入院时进行CAR评估可能是长期死亡率的可行预测指标。
