Department of Haemodialysis, Fuyong People's Hospital of Baoan District, Shenzhen, 518103, Guangdong Province, People's Republic of China.
Department of Urology, Fuyong People's Hospital of Baoan District, Shenzhen, 518103, Guangdong Province, People's Republic of China.
Eur J Med Res. 2024 Nov 5;29(1):530. doi: 10.1186/s40001-024-02127-5.
The relationship between serum albumin and prognosis in critically ill patients has been studied, however, there is a paucity of exploration into non-linear relationships, particularly in critically ill patients undergoing dialysis. This study intends to investigate the association between serum albumin (ALB) and 28 day mortality in critically ill patients undergoing dialysis.
We conducted a multi-center retrospective cohort study of patients undergoing dialysis by utilising data from the eICU Collaborative Research Database from 208 distinct ICUs across the United States between 2014 and 2015. The study focused on mortality within 28 days of ICU admission. We employed univariate analysis, multi-factor logistic regression, subgroup analysis, curve-fitting, and threshold effect analysis to examine the correlation between ALB levels and 28 day mortality.
Among the 2,315 patients with a median age of 63 years, 205 (8.86%) died within 28 days of ICU admission. When ALB level was < 2.7 g/dL, the mortality decreased with an adjusted odds ratio (OR) of 0.34 (95% CI 0.22-0.51, P < 0.0001) for every 1 increment in the ALB. However, no significant mortality changes were observed when ALB levels were at or above this threshold.
Our study identifies a nonlinear dose-response relationship between serum ALB levels and 28 day mortality in critically ill patients undergoing dialysis, with a specific turning point observed. This finding underscores a significant negative correlation between ALB levels and mortality risk, with lower ALB levels being associated with higher mortality risk in this particular population.
已有研究探讨了血清白蛋白与危重症患者预后之间的关系，但对于非线性关系，特别是在接受透析的危重症患者中，研究还很匮乏。本研究旨在探讨血清白蛋白（ALB）与接受透析的危重症患者 28 天死亡率之间的关系。
我们利用美国 208 家不同 ICU 的 eICU 协作研究数据库中 2014 年至 2015 年的数据，进行了一项多中心回顾性队列研究，纳入了接受透析的患者。本研究主要关注 ICU 入院后 28 天内的死亡率。我们采用单因素分析、多因素逻辑回归、亚组分析、曲线拟合和阈值效应分析来检验 ALB 水平与 28 天死亡率之间的相关性。
在中位年龄为 63 岁的 2315 例患者中，有 205 例（8.86%）在 ICU 入院后 28 天内死亡。当 ALB 水平<2.7 g/dL 时，ALB 每增加 1 个单位，调整后的优势比（OR）为 0.34（95%CI 0.22-0.51，P<0.0001），死亡风险降低。然而，当 ALB 水平达到或高于该阈值时，死亡率没有明显变化。
本研究发现，在接受透析的危重症患者中，血清 ALB 水平与 28 天死亡率之间存在非线性剂量反应关系，存在特定的转折点。这一发现突显了 ALB 水平与死亡率风险之间存在显著的负相关关系，在这一特定人群中，ALB 水平较低与更高的死亡率风险相关。
