Wang Shaobo, Huang Bin, Xu Yuxin, Wei Bingyu, Long Rongfang, Qiu Ying
Department of Critical Care Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
Department of Critical Care Medicine, Guangxi Liugang Medical Co., Ltd. Hospital, Liuzhou 545002, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jul;37(7):633-637. doi: 10.3760/cma.j.cn121430-20250311-00234.
To investigate the value of difference between hematocrit (HCT) and albumin (Alb) in predicting the prognosis of patients with sepsis.
A retrospective study was conducted on the septic patients hospitalized at the First Affiliated Hospital of Guangxi Medical University from January to October in 2024. Clinical data including gender, age, body mass index (BMI), history of hypertension or diabetes, vital signs on admission, and sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, blood lactic acid (Lac), oxygenation index (PaO/FiO), hemoglobin (Hb), white blood cell count (WBC), platelet count (PLT), lymphocyte count (LYM), HCT, Alb, difference between HCT and Alb, bilirubin, scrum creatinine (SCr), and fibrinogen (Fib) within 48 hours of admission were collected. The 28-day prognosis of patients was also recorded. Binary multivariate Logistic regression analysis was used to identify risk factors for 28-day death in patients with sepsis. The predictive efficacy of the difference between HCT and Alb on 28-day death was evaluated using the receiver operator characteristic curve (ROC curve).
Among 180 enrolled septic patients, 140 survived and 40 died on 28 days. Compared with the survival group, the patients in the death group was significantly older (years old: 64±16 vs. 55±15, P < 0.05), and had higher SOFA score, APACHE II score, and SCr [SOFA score: 6 (4, 9) vs. 3 (2, 5), APACHE II score: 13 (10, 18) vs. 8 (6, 11), SCr (μmol/L): 136 (70, 416) vs. 77 (58, 126), all P < 0.05] as well as lower Hb, PLT, HCT, difference between HCT and Alb, and Fib within 48 hours of admission [Hb (g/L): 90±30 vs. 106±79, PLT (×10/L): 158 (57, 240) vs. 215 (110, 315), HCT: 0.258±0.081 vs. 0.333±0.077, difference between HCT and Alb: -6.52±7.40 vs. 1.07±7.63, Fib (g/L): 3.72±1.57 vs. 4.59±1.55, all P < 0.05]. No significant difference in gender, BMI, history of hypertension or diabetes, vital signs on admission, or other laboratory indicators was found between the two groups. Binary multivariate Logistic regression analysis revealed that age [odds ratio (OR) = 1.040, 95% confidence interval (95%CI) was 1.004-1.078, P = 0.030], APACHE II score (OR = 1.218, 95%CI was 1.038-1.430, P = 0.016), Hb (OR = 1.040, 95%CI was 1.014-1.068, P = 0.003), and difference between HCT and Alb (OR = 0.804, 95%CI was 0.727-0.889, P < 0.001) were independent risk factors for 28-day death of septic patients. ROC curve analysis showed that the area under the ROC curve (AUC) of difference between HCT and Alb for predicting 28-day death of septic patients was 0.764 (95%CI was 0.679-0.849, P < 0.001). A cut-off value of difference between HCT and Alb ≤ -5.35 yielded a sensitivity of 80.7% and specificity of 65.0%.
The difference between HCT and Alb at early admission is a valuable predictor of prognosis in septic patients. A difference ≤ -5.35 indicates an increased death risk of septic patients.
探讨血细胞比容（HCT）与白蛋白（Alb）的差值在预测脓毒症患者预后中的价值。
对2024年1月至10月在广西医科大学第一附属医院住院的脓毒症患者进行回顾性研究。收集患者的临床资料，包括性别、年龄、体重指数（BMI）、高血压或糖尿病病史、入院时生命体征、序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康状况评分系统II（APACHE II）评分、血乳酸（Lac）、氧合指数（PaO/FiO）、血红蛋白（Hb）、白细胞计数（WBC）、血小板计数（PLT）、淋巴细胞计数（LYM）、HCT、Alb、HCT与Alb的差值、胆红素、血肌酐（SCr）和纤维蛋白原（Fib）。记录患者的28天预后情况。采用二元多因素Logistic回归分析确定脓毒症患者28天死亡的危险因素。使用受试者工作特征曲线（ROC曲线）评估HCT与Alb的差值对28天死亡的预测效能。
180例纳入研究的脓毒症患者中，140例存活，40例在28天时死亡。与存活组相比，死亡组患者年龄显著更大（岁：64±16 vs. 55±15，P<0.05），且SOFA评分、APACHE II评分和SCr更高[SOFA评分：6（4，9）vs. 3（2，5），APACHE II评分：13（10，18）vs. 8（6，11），SCr（μmol/L）：136（70，416）vs. 77（58，126），均P<0.05]，而入院后48小时内的Hb、PLT、HCT、HCT与Alb的差值及Fib更低[Hb（g/L）：90±30 vs. 106±79，PLT（×10/L）：158（57，240）vs. 215（110，315），HCT：0.258±0.081 vs. 0.333±0.077，HCT与Alb的差值：-6.52±7.40 vs. 1.07±7.63，Fib（g/L）：3.72±1.57 vs. 4.59±1.55，均P<0.05]。两组在性别、BMI、高血压或糖尿病病史、入院时生命体征或其他实验室指标方面无显著差异。二元多因素Logistic回归分析显示，年龄[比值比（OR）=1.040，95%置信区间（95%CI）为1.004 - 1.078，P = 0.030]、APACHE II评分（OR = 1.218，95%CI为1.038 - 1.430，P = 0.016）、Hb（OR = 1.040，95%CI为1.014 - 1.068，P = 0.003）以及HCT与Alb的差值（OR = 0.804，95%CI为0.727 - 0.889，P<0.001）是脓毒症患者28天死亡的独立危险因素。ROC曲线分析显示，HCT与Alb的差值预测脓毒症患者28天死亡的ROC曲线下面积（AUC）为0.764（95%CI为0.679 - 0.849，P<0.001）。HCT与Alb的差值≤ - 5.35时，灵敏度为80.7%，特异度为65.0%。
入院早期HCT与Alb的差值是脓毒症患者预后的有价值预测指标。差值≤ - 5.35表明脓毒症患者死亡风险增加。
