老年脓毒症重症患者血清肌酐与白蛋白比值与28天全因死亡率的关联：MIMIC-IV数据库的回顾性分析

Association of serum creatinine-to-albumin ratio with 28-day all-cause mortality in older adults critically ill patients with sepsis: a retrospective analysis of the MIMIC-IV database.

作者信息

Zhao Lixin, Chai Haixia, Yu Sifang, Chen Fang, Zhang Caiyun, Liu Yancun, Chai Yanfen

机构信息

Department of Emergency Medicine, Tianjin Medical University General Hospital, NO.154 Anshan Road, Heping District, 300052, Tianjin, China.

The Second Department of Critical Care Medicine, Tangshan Gongren Hospital, No. 27 Wenhua Road, Lubei District, Tangshan, Hebei, 063001, China.

出版信息

BMC Geriatr. 2025 Jul 2;25(1):477. doi: 10.1186/s12877-025-06093-3.

DOI:10.1186/s12877-025-06093-3

PMID:40604550

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12219694/

Abstract

BACKGROUND

Sepsis has posed a significant global public health challenge, with advanced age, chronic diseases, and medication history in the older adults population significantly increasing the risk of organ failure or death. Serum creatinine (Cr) and albumin (Alb) are important predictors of mortality in individuals with various diseases. Therefore, our research aimed to evaluate the relationship between serum creatinine to albumin ratio (CAR) and 28-day all-cause mortality in older adults patients with sepsis.

METHODS

Using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, we identified older adults patients with sepsis and applied Kaplan-Meier (K-M) curves and multivariable logistic regression to evaluate the association between CAR and 28-day all-cause mortality. Restricted cubic spline (RCS) analysis explored the nonlinear relationship, and subgroup analyses were conducted.

RESULTS

After applying inclusion and exclusion criteria, a total of 2,350 older adults patients with sepsis were enrolled, among whom the proportion of non-survivors was 34.89%. Survivors had longer hospital stays and lower CAR. Patients in the highest CAR quartile (Q4) exhibited significantly higher levels of creatinine, and various disease scores. Additionally, the 28-day all-cause mortality in the ICU for the Q4 group was significantly higher than in the other groups ( < 0.0001). After adjusting for confounding factors, the 28-day ICU all-cause mortality was still significantly increased, with a nonlinear relationship ( < 0.001). This association was further confirmed in subgroup analyses, where the predictive value of CAR for 28-day all-cause mortality in the ICU remained consistent across subgroups stratified by comorbidities and individual patient characteristics.

CONCLUSIONS

The MIMIC-IV database revealed a positive association between serum CAR and short-term all-cause mortality in older adults patients with sepsis, with a nonlinear relationship. This research enhances our understanding of the association between serum-based biomarkers and prognosis in older adults patients with sepsis.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12877-025-06093-3.

摘要

背景

脓毒症已成为一项重大的全球公共卫生挑战，老年人中的高龄、慢性病和用药史显著增加了器官衰竭或死亡的风险。血清肌酐（Cr）和白蛋白（Alb）是各种疾病患者死亡率的重要预测指标。因此，我们的研究旨在评估老年人脓毒症患者血清肌酐与白蛋白比值（CAR）与28天全因死亡率之间的关系。

方法

使用重症监护医学信息集市IV（MIMIC-IV）数据库，我们识别出老年人脓毒症患者，并应用Kaplan-Meier（K-M）曲线和多变量逻辑回归来评估CAR与28天全因死亡率之间的关联。限制立方样条（RCS）分析探索了非线性关系，并进行了亚组分析。

结果

应用纳入和排除标准后，共纳入2350例老年人脓毒症患者，其中非幸存者比例为34.89%。幸存者住院时间更长，CAR更低。CAR最高四分位数（Q4）组的患者肌酐水平和各种疾病评分显著更高。此外，Q4组在重症监护病房（ICU）的28天全因死亡率显著高于其他组（<0.0001）。在调整混杂因素后，ICU的28天全因死亡率仍显著增加，呈非线性关系（<0.001）。这种关联在亚组分析中得到进一步证实，在按合并症和个体患者特征分层的亚组中，CAR对ICU 28天全因死亡率的预测价值保持一致。