脓毒症患者24小时尿量与28天重症监护病房死亡率之间的关联：一项多中心回顾性队列研究
Association between 24-hour urine volume and 28-day intensive care unit mortality in sepsis patients: a multi-center retrospective cohort study.
作者信息
Lin Yuzhan, Lin Weiguo, Fu Cheng, Sun Ruixue, Hong WeiLi, Chen Xinglin, Yan Shaorong
机构信息
Department of Clinical Laboratory, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, Zhejiang, China.
Department of Urology, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, Zhejiang, China.
出版信息
Front Med (Lausanne). 2024 Nov 26;11:1486232. doi: 10.3389/fmed.2024.1486232. eCollection 2024.
BACKGROUND
Sepsis is defined as a dysregulated host response to infection that results in life-threatening organ dysfunction. The 24-hour urine volume plays a crucial role in assessing the prognosis of septic patients. This study aims to investigate the relationship between 24-hour urine volume and 28-day intensive care unit (ICU) mortality in septic patients and exploring the dose-response relationship between these variables.
METHODS
This retrospective cohort study analyzed data from 7,218 sepsis patients in the eICU Collaborative Research Database. Logistic regression models and generalized additive models were used to examine the relationship between 24-hour urine volume and 28-day ICU mortality.
RESULTS
A negative correlation was found between 24-hour urine volume and ICU 28-day mortality. In the fully adjusted model, each 50 mL increase in 24-hour urine volume significantly reduced mortality risk by 1% (OR = 0.99, 95% CI = 0.98-0.99, < 0.001). A nonlinear dose-response relationship was observed, with an inflection point at ~1,663.5 ml. Below this threshold, increased urine volume was significantly associated with reduced mortality risk (OR = 0.97, 95% CI: 0.96-0.98, < 0.001), while above this point, the relationship was not statistically significant.
CONCLUSION
This study demonstrates a non-linear negative correlation between 24-hour urine volume and 28-day ICU mortality in sepsis patients.
背景
脓毒症被定义为宿主对感染的失调反应，可导致危及生命的器官功能障碍。24小时尿量在评估脓毒症患者的预后中起着关键作用。本研究旨在探讨脓毒症患者24小时尿量与28天重症监护病房（ICU）死亡率之间的关系，并探索这些变量之间的剂量反应关系。
方法
这项回顾性队列研究分析了eICU协作研究数据库中7218例脓毒症患者的数据。采用逻辑回归模型和广义相加模型来检验24小时尿量与28天ICU死亡率之间的关系。
结果
发现24小时尿量与ICU 28天死亡率之间呈负相关。在完全调整模型中，24小时尿量每增加50 mL，死亡风险显著降低1%（比值比=0.99，95%置信区间=0.98-0.99，P<0.001）。观察到一种非线性剂量反应关系，拐点约为1663.5 ml。低于该阈值，尿量增加与死亡风险降低显著相关（比值比=0.97，95%置信区间：0.96-0.98，P<0.001），而高于该点，这种关系无统计学意义。
结论
本研究表明脓毒症患者24小时尿量与28天ICU死亡率之间存在非线性负相关。
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