心力衰竭患者中白蛋白校正阴离子间隙与急性肾损伤的关联：一项竞争风险模型分析

The association of albumin-corrected anion gap and acute kidney injury in heart failure patients: a competing risk model analysis.

作者信息

Ruan Ai-Fang, Zheng Jian-Wu, Sun Shao-Qing, Liu Xu-Zhu, Chen Tie-Long

机构信息

Department of cardiovascular medicine, Hangzhou Lin'an District Hospital of Traditional Chinese Medicine, Hangzhou, 311300, Zhejiang, China.

Department of cardiovascular medicine, Hangzhou Hospital of Traditional Chinese Medicine, No.453 Stadium Road, Xihu District, Hangzhou, 310007, Zhejiang, China.

出版信息

BMC Cardiovasc Disord. 2025 Apr 11;25(1):277. doi: 10.1186/s12872-025-04723-7.

DOI:10.1186/s12872-025-04723-7

PMID:40217175

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11987305/

Abstract

BACKGROUND

The combination of heart failure (HF) and acute kidney injury (AKI) increases the mortality of patients. It is critical to identify HF patients who may have a high risk for AKI. Albumin-corrected anion gap (ACAG) is a new indicator, but there are no studies on ACAG and the risk of AKI in HF patients.

METHODS

Data for HF patients was obtained from the MIMIC-IV database. Receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) were employed to evaluate the clinical value of ACAG in predicting AKI risk. Logistic regression analysis and restricted cubic spline (RCS) curve were conducted to explore the relationship between ACAG and AKI. A competing risk model was developed to further investigate the relationship between ACAG on AKI.

RESULTS

The study analyzed 5,972 HF patients, with 49.82% (2886/5972) suffering from AKI. The prediction performance of ACAG on AKI was good (AUC:0.656). Continuous ACAG was associated with AKI after adjusting for various significant variables (Model 1: OR = 1.094, 95%CI: 1.078-1.110; Model 2: OR = 1.150, 95%CI: 1.133-1.166; Model 3: OR = 1.035, 95%CI. 1.017-1.054). All High ACAG groups showed a higher risk of AKI (all P < 0.001). ACAG was also linked to in-hospital mortality (P < 0.001). The competing risks model revealed that high ACAG was still a risk factor for AKI when in-hospital mortality served as a competing risk event (P < 0.001).

CONCLUSION

High ACAG was associated with the risk of AKI in HF patients. Clinicians can risk-stratify HF patients by combining ACAG levels.

摘要

背景

心力衰竭（HF）与急性肾损伤（AKI）并存会增加患者的死亡率。识别可能具有高AKI风险的HF患者至关重要。白蛋白校正阴离子间隙（ACAG）是一项新指标，但尚无关于ACAG与HF患者AKI风险的研究。

方法

从MIMIC-IV数据库获取HF患者的数据。采用受试者工作特征（ROC）分析和决策曲线分析（DCA）评估ACAG在预测AKI风险中的临床价值。进行逻辑回归分析和受限立方样条（RCS）曲线分析以探索ACAG与AKI之间的关系。建立竞争风险模型以进一步研究ACAG与AKI之间的关系。

结果

该研究分析了5972例HF患者，其中49.82%（2886/5972）发生AKI。ACAG对AKI的预测性能良好（AUC：0.656）。校正各种显著变量后，连续ACAG与AKI相关（模型1：OR = 1.094，95%CI：1.078 - 1.110；模型2：OR = 1.150，95%CI：1.133 - 1.166；模型3：OR = 1.035，95%CI：1.017 - 1.054）。所有高ACAG组的AKI风险均较高（所有P < 0.001）。ACAG也与住院死亡率相关（P < 0.001）。竞争风险模型显示，当住院死亡率作为竞争风险事件时，高ACAG仍是AKI的危险因素（P < 0.001）。