心力衰竭中血尿素氮与肌酐比值及估计血浆容量状态的预测价值
Predictive value of blood urea nitrogen to creatinine ratio and estimated plasma volume status in heart failure.
作者信息
Zheng Xiaoxue, Tan Long, Cheng Yalin, Huang Dahai
机构信息
Department of Health Care, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Health Service Department, Guard Bureau of the General Office of the Central Committee of the Communist Party of China, Beijing, 100017, China.
出版信息
BMC Cardiovasc Disord. 2025 Apr 12;25(1):282. doi: 10.1186/s12872-025-04717-5.
BACKGROUND
The blood urea nitrogen to creatinine ratio (BCR) and estimated plasma volume status (ePVS) may be prognostic markers in heart failure (HF), but their combined efficacy is unclear. This research aims to determine the prognostic utility of BCR and ePVS in critically ill HF patients in the intensive care unit.
METHODS
Data from the MIMIC-IV database were analyzed. ePVS was calculated using hemoglobin and hematocrit levels with Strauss-derived Duarte method. The primary outcome was 1-year all-cause mortality (ACM). Receiver operating characteristic (ROC) curves identified cutoff values for BCR and ePVS. To assess the connection between BCR, ePVS, and 1-year ACM, the Kaplan-Meier (KM) method, Cox proportional hazards models, subgroup analysis, and limited cubic spline were employed. Harrell's C statistic evaluated predictive power.
RESULTS
Among 11,066 participants, optimal thresholds for mortality were BCR > 22.81 and ePVS > 7.16 ml/g. BCR demonstrated a non-linear J-shaped correlation with ACM, while ePVS displayed a linear relationship. Multivariate Cox analysis indicated higher level of BCR was linked to higher 1-year ACM (HR = 1.39, 95% CI: 1.30-1.49, P < 0.001), as was increased level of ePVS (HR = 1.09, 95% CI: 1.02-1.16, P = 0.012). Notably, HF patients with both high BCR and ePVS faced a significantly greater mortality risk than those with lower levels of both markers (HR = 1.54, 95% CI: 1.40-1.69, P < 0.001). Combining BCR and ePVS improved prognostic accuracy.
CONCLUSIONS
BCR and ePVS independently predict 1-year ACM in HF patients, with their combined use offering improved prognostic accuracy.
背景
血尿素氮与肌酐比值（BCR）和估计血浆容量状态（ePVS）可能是心力衰竭（HF）的预后标志物，但其联合疗效尚不清楚。本研究旨在确定BCR和ePVS在重症监护病房中危重心力衰竭患者中的预后效用。
方法
分析了多中心重症医学信息库第四版（MIMIC-IV）数据库中的数据。使用血红蛋白和血细胞比容水平，采用施特劳斯推导的杜阿尔特方法计算ePVS。主要结局是1年全因死亡率（ACM）。通过受试者工作特征（ROC）曲线确定BCR和ePVS的临界值。为了评估BCR、ePVS与1年ACM之间的关联，采用了Kaplan-Meier（KM）法、Cox比例风险模型、亚组分析和受限立方样条法。Harrell's C统计量评估预测能力。
结果
在11066名参与者中，死亡率的最佳阈值为BCR>22.81和ePVS>7.16 ml/g。BCR与ACM呈非线性J形相关，而ePVS呈线性关系。多变量Cox分析表明，较高的BCR水平与较高的1年ACM相关（风险比[HR]=1.39，95%置信区间[CI]：1.30-1.49，P<0.001），ePVS水平升高也与较高的1年ACM相关（HR=1.09，95%CI：1.02-1.16，P=0.012）。值得注意的是，BCR和ePVS均高的HF患者的死亡风险明显高于两者水平较低的患者（HR=1.54，95%CI：1.40-1.69，P<0.001）。结合BCR和ePVS可提高预后准确性。
结论
BCR和ePVS可独立预测HF患者的1年ACM，联合使用可提高预后准确性。
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