Hu Zhenkui, Song Chao, Zhang Jinhui
Department of Emergency Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, China.
Department of Critical Care Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, China.
Front Med (Lausanne). 2024 Sep 19;11:1436533. doi: 10.3389/fmed.2024.1436533. eCollection 2024.
The aim of this study was to examine the prognostic significance of serum albumin-to-creatinine ratio (ACR) in critically ill patients with sepsis.
This retrospective study analyzed sepsis cases admitted to the Affiliated Hospital of Jiangsu University between January 2015 and November 2023. The patients were divided into four groups based on their ACR upon admission to the intensive care unit (ICU). Laboratory data were collected at the time of ICU admission, and the primary outcome measure was in-hospital all-cause mortality. Kaplan-Meier survival curves were generated to illustrate the differences in 30-/60-day mortality among the various groups. Multivariate Cox regression models and restricted cubic splines (RCS) were utilized to explore the association between ACR and all-cause mortality in sepsis patients. Subgroup analyses were conducted to examine the impact of other covariates on the relationship between ACR and all-cause mortality.
A total of 1,123 eligible patients were included in the study, with a median ACR of 0.169. The in-hospital mortality rate was 33.7%, the ICU mortality rate was 31.9%, and the 30-day mortality rate was 28.1%. Kaplan-Meier survival analysis demonstrated that patients with higher ACR had a significantly lower risk of 30-/60-day mortality (log-rank < 0.001). Multivariable Cox proportional hazards analyses revealed that ACR was an independent predictor of in-hospital death (HR: 0.454, 95% CI 0.271-0.761, = 0.003), ICU death (HR: 0.498, 95% CI 0.293-0.847, = 0.010), and 30-day death (HR: 0.399, 95% CI 0.218-0.730, = 0.003). For each 1-unit increase in ACR, there was a 1.203-fold decrease in the risk of death during the hospital stay. The RCS curve illustrated a non-linear negative correlation between ACR and in-hospital mortality (p for non-linear =0.018), ICU mortality ( for non-linear =0.005), and 30-day mortality ( for non-linear =0.006). Sensitivity analysis indicated consistent effect sizes and directions in different subgroups, confirming the stability of the results.
Low ACR levels were identified as independent risk factors associated with increased in-hospital, ICU, and 30-day mortality in sepsis patients. ACR can serve as a significant predictor of the clinical outcome of sepsis.
本研究旨在探讨血清白蛋白与肌酐比值（ACR）在重症脓毒症患者中的预后意义。
这项回顾性研究分析了2015年1月至2023年11月期间入住江苏大学附属医院的脓毒症病例。根据患者入住重症监护病房（ICU）时的ACR将其分为四组。在入住ICU时收集实验室数据，主要结局指标为院内全因死亡率。绘制Kaplan-Meier生存曲线以说明各组之间30/60天死亡率的差异。采用多变量Cox回归模型和限制性立方样条（RCS）来探讨ACR与脓毒症患者全因死亡率之间的关联。进行亚组分析以检验其他协变量对ACR与全因死亡率之间关系的影响。
本研究共纳入1123例符合条件的患者，ACR中位数为0.169。院内死亡率为33.7%，ICU死亡率为31.9%，30天死亡率为28.1%。Kaplan-Meier生存分析表明，ACR较高的患者30/60天死亡风险显著较低（对数秩检验<0.001）。多变量Cox比例风险分析显示，ACR是院内死亡（HR：0.454，95%CI 0.271 - 0.761，P = 0.003）、ICU死亡（HR：0.498，95%CI 0.293 - 0.847，P = 0.010）和30天死亡（HR：0.399，95%CI 0.218 - 0.730，P = 0.003）的独立预测因素。ACR每增加1个单位，住院期间死亡风险降低1.203倍。RCS曲线显示ACR与院内死亡率（非线性P = 0.018）、ICU死亡率（非线性P = 0.005）和30天死亡率（非线性P = 0.006）之间呈非线性负相关。敏感性分析表明不同亚组的效应大小和方向一致，证实了结果的稳定性。
低ACR水平被确定为脓毒症患者院内、ICU和30天死亡率增加的独立危险因素。ACR可作为脓毒症临床结局的重要预测指标。
