慢性肾脏病危重症患者血尿素氮与血糖比值与365天死亡率的相关性:一项回顾性研究
Association of blood urea nitrogen to glucose ratio with 365-day mortality in critically ill patients with chronic kidney disease: a retrospective study.
作者信息
Du Shenghua, Yu Zhaoxian, Li Junghong, Jiang Yingyi, Wang Juan, Hu Jinxing, Su Ning
机构信息
Department of Nephrology, Guangzhou Chest Hospital, Guangzhou Medical University, Guangzhou, China.
State Key Laboratory of Respiratory Disease, Guangzhou Key Laboratory of Tuberculosis, Department of Critical Care Medicine, Guangzhou Chest Hospital, Institute of Tuberculosis, Guangzhou Medical University, Guangzhou, China.
出版信息
Sci Rep. 2025 Feb 25;15(1):6697. doi: 10.1038/s41598-025-91012-0.
Low blood glucose levels and high urea nitrogen levels affect patient prognosis, but few studies have investigated whether the blood urea nitrogen to glucose (BGR) ratio predicts the risk of death.This retrospective research examined the connection between the BGR and 365-day mortality in patients with chronic kidney disease (CKD) stages 1-4 admitted to an intensive care unit (ICU). The study utilized data from 6,380 patients in the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-IV v2.2), taking into account confounding factors such as demographics, vital signs, laboratory indicators, and comorbidities. The study employed both univariate and multivariate Cox regression analyses stratified by BGR quartiles. Additionally, restricted cubic spline regression and inflection point analysis were used to explore the linear relationship between BGR and 365-day mortality, while Kaplan-Meier curve analysis was used to observe mortality changes under different BGR stratifications. Subgroup and mediating effect analyses were performed to evaluate the robustness of BGR's effect on 365-day mortality. The study found a cumulative 365-day mortality rate of 34.2% among CKD stages 1-4 patients, with a 2.43-fold increase in the risk of death associated with BGR and at least a 44% increase in the risk of death for each unit increase in BGR (P = 0.022). A significant nonlinear relationship was identified, showing a stepwise change in the risk of death with a marked increase in the slope of the curve for BGR values below 0.52 and above 0.9 (P < 0.001). Subgroup analyses indicated interactions between BGR and factors such as age, sepsis, first-day antibiotic use, and cerebrovascular disease (P < 0.05). In conclusion, this study confirms that BGR is a significant and stable predictor of 1-year mortality risk in patients with CKD stages 1-4. Interventions aimed at timely adjustment, correction of metabolic imbalances, reduction of inflammation, and management of BGR levels are beneficial for reducing mortality in this patient population.
低血糖水平和高尿素氮水平会影响患者预后,但很少有研究调查血尿素氮与血糖(BGR)比值是否能预测死亡风险。这项回顾性研究考察了入住重症监护病房(ICU)的1-4期慢性肾脏病(CKD)患者的BGR与365天死亡率之间的关联。该研究利用了重症监护医学信息数据库第四版2.2(MIMIC-IV v2.2)中6380名患者的数据,同时考虑了人口统计学、生命体征、实验室指标和合并症等混杂因素。该研究采用单因素和多因素Cox回归分析,并按BGR四分位数进行分层。此外,使用受限立方样条回归和拐点分析来探究BGR与365天死亡率之间的线性关系,同时使用Kaplan-Meier曲线分析来观察不同BGR分层下的死亡率变化。进行亚组分析和中介效应分析以评估BGR对365天死亡率影响的稳健性。研究发现,1-4期CKD患者的365天累积死亡率为34.2%,BGR相关的死亡风险增加2.43倍,且BGR每升高一个单位,死亡风险至少增加44%(P = 0.022)。研究确定了一种显著的非线性关系,即当BGR值低于0.52和高于0.9时,死亡风险呈逐步变化,曲线斜率显著增加(P < 0.001)。亚组分析表明BGR与年龄、脓毒症、首日使用抗生素和脑血管疾病等因素之间存在相互作用(P < 0.05)。总之,本研究证实BGR是1-4期CKD患者1年死亡风险的重要且稳定的预测指标。旨在及时调整、纠正代谢失衡、减轻炎症和控制BGR水平的干预措施,有利于降低该患者群体的死亡率。