慢性阻塞性肺疾病急性加重患者乳酸脱氢酶与白蛋白比值及预后：一项回顾性队列研究
Lactate dehydrogenase to albumin ratio and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study.
作者信息
Ding Chao-Wei, Huang Shen-Shen, Xu Yan-Hong, Chu Xu, Wang Lan, Mao Yi-Min, Yuan Ya-Dong, Qiu Jia-Yong
机构信息
Department of Respiratory and Critical Care Medicine, Xiamen Humanity Hospital Fujian Medical University, Xiamen, Fujian, 361000, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Clinical Medicine of Henan, University of Science and Technology, Luoyang, 471003, China.
出版信息
BMC Pulm Med. 2025 Apr 4;25(1):154. doi: 10.1186/s12890-025-03622-z.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a global public health challenge and a major cause of death. The lactate dehydrogenase to albumin ratio (LAR) is a simple and practical indicator of disease prognosis, but its prognostic value in acute exacerbation of COPD (AECOPD) remains unclear. Therefore, we aimed to explore the prognostic value of LAR for the short-term all-cause mortality risk in patients with AECOPD.
METHODS
This retrospective cohort study included 654 patients with AECOPD from the MIMIC-IV database. LAR was analyzed after natural logarithm transformation and the patients were divided into three groups. The clinical outcome was the 1-month and 3-months all-cause mortality. The relationship between LAR and all-cause mortality was assessed using Kaplan-Meier survival analysis and a Cox regression model. Generalized additive models were employed to identify non-linear relationships, and a subgroup analysis was performed to determine the stability of the results.
RESULTS
The study showed that LAR levels significantly and positively correlated with short-term all-cause mortality in patients with AECOPD. Compared to the low LAR group, patients in the medium LAR group had a significantly increased 1-month all-cause mortality risk, with a hazard ratio (HR) of 1.74 (95% [Confidence Interval, CI] 1.16-2.63, P = 0.008). Patients in the high LAR group had an even higher 1-month all-cause mortality risk, with an HR of 2.58 (95% CI 1.75-3.80, P < 0.001). For 3-month all-cause mortality, patients in the medium LAR group had an HR of 1.54 (95% CI 1.10-2.16, P = 0.012), while those in the high LAR group had an HR of 2.18 (95% CI 1.58-3.01, P < 0.001). The results remained stable in all three adjusted models and in the subgroup analyses. The relationship between LAR and all-cause mortality due to AECOPD was non-linear, with inflection points at 8.13 and 6.05 for 1-month and 3-month all-cause mortality, respectively.
CONCLUSIONS
Elevated LAR is an independent predictive indicator of short-term all-cause mortality risk in patients with AECOPD and can be used to improve decision-making for the clinical management of these patients.
CLINICAL TRIAL NUMBER
Not applicable.
背景
慢性阻塞性肺疾病（COPD）是一项全球性的公共卫生挑战，也是主要的死亡原因。乳酸脱氢酶与白蛋白比值（LAR）是一种简单实用的疾病预后指标，但其在慢性阻塞性肺疾病急性加重（AECOPD）中的预后价值仍不明确。因此，我们旨在探讨LAR对AECOPD患者短期全因死亡风险的预后价值。
方法
这项回顾性队列研究纳入了MIMIC-IV数据库中的654例AECOPD患者。对LAR进行自然对数转换后进行分析，并将患者分为三组。临床结局为1个月和3个月时的全因死亡率。采用Kaplan-Meier生存分析和Cox回归模型评估LAR与全因死亡率之间的关系。采用广义相加模型识别非线性关系，并进行亚组分析以确定结果的稳定性。
结果
研究表明，AECOPD患者的LAR水平与短期全因死亡率显著正相关。与低LAR组相比，中LAR组患者1个月全因死亡风险显著增加，风险比（HR）为1.74（95%置信区间[CI]1.16-2.63，P = 0.008）。高LAR组患者1个月全因死亡风险更高，HR为2.58（95%CI 1.75-3.80，P < 0.001）。对于3个月全因死亡率，中LAR组患者HR为1.54（95%CI 1.10-2.16，P = 0.012），而高LAR组患者HR为2.18（95%CI 1.58-3.01，P < 0.001）。在所有三个校正模型和亚组分析中，结果均保持稳定。LAR与AECOPD导致的全因死亡率之间的关系是非线性的，1个月和3个月全因死亡率的拐点分别为8.13和6.05。
结论
LAR升高是AECOPD患者短期全因死亡风险的独立预测指标，可用于改善这些患者临床管理的决策。
临床试验编号
不适用。
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