乳酸/白蛋白比值联合NLR构建的列线图对急性呼吸窘迫综合征患者早期预后的预测价值
The predictive value of nomogram based on lactate-to-albumin ratio combined with NLR for early prognosis of patients with acute respiratory distress syndrome
- 解放军医学杂志 2023年48卷第10期 页码：1194-1200
- 作者机构：
1.兰州大学第二医院重症医学科，甘肃兰州 730030
2.甘肃省肿瘤医院麻醉科，甘肃兰州 730050
- 作者简介：
罗延年，硕士研究生，主治医师，主要从事重症呼吸及循环系统疾病相关研究
曹雯，E-mail：smilecao2009@126.com
- 基金信息：兰州市科技发展指导性计划项目(2020-ZD-48)
DOI：10.11855/j.issn.0577-7402.2364.2023.0718
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罗延年, 席振创, 王锐, 等. 乳酸/白蛋白比值联合NLR构建的列线图对急性呼吸窘迫综合征患者早期预后的预测价值[J]. 解放军医学杂志, 2023, 48(10): 1194-1200.
Luo Yan-Nian,Xi Zhen-Chuang,Wang Rui,et al.The predictive value of nomogram based on lactate-to-albumin ratio combined with NLR for early prognosis of patients with acute respiratory distress syndrome[J].Medical Journal of Chinese People′s Liberation Army,2023,48(10):1194-1200.
罗延年, 席振创, 王锐, 等. 乳酸/白蛋白比值联合NLR构建的列线图对急性呼吸窘迫综合征患者早期预后的预测价值[J]. 解放军医学杂志, 2023, 48(10): 1194-1200. DOI： 10.11855/j.issn.0577-7402.2364.2023.0718.
Luo Yan-Nian,Xi Zhen-Chuang,Wang Rui,et al.The predictive value of nomogram based on lactate-to-albumin ratio combined with NLR for early prognosis of patients with acute respiratory distress syndrome[J].Medical Journal of Chinese People′s Liberation Army,2023,48(10):1194-1200. DOI： 10.11855/j.issn.0577-7402.2364.2023.0718.
摘要
目的,2,探讨乳酸/白蛋白比值(L/A)联合中性粒细胞/淋巴细胞比值(NLR)构建的列线图对急性呼吸窘迫综合征(ARDS)患者早期预后的预测价值。,方法,2,回顾性分析2018年3月－2022年6月兰州大学第二医院重症医学科收治的115例ARDS患者，根据治疗后28 d临床结局分为生存组(,n=,62)与死亡组(,n=,53)。收集并比较两组临床资料，包括入院24 h内血常规、血清白蛋白、血气分析结果，序贯器官衰竭评分(SOFA评分)、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、Murray肺损伤评分(Murray评分)、脏器衰竭数目、ARDS来源、ICU住院时间、机械通气时间、28 d死亡情况，并计算L/A及NLR。采用单因素及多因素logistic回归分析ARDS预后的独立危险因素并构建列线图预测模型，绘制列线图实现模型可视化。采用受试者工作特征曲线(ROC)和校准曲线验证列线图的准确度，并通过决策曲线分析评价列线图的临床预测效能。,结果,2,死亡组年龄，APACHE Ⅱ、SOFA、Murray 评分，脏器衰竭数目，肺源性ARDS占比，中性粒细胞计数(NEU)、NLR、L/A，以及血乳酸水平均明显高于生存组，氧合指数(PaO,2,/FiO,2,)、肺外源性ARDS占比、淋巴细胞计数(LYM)、血小板计数(PLT)均低于生存组，差异有统计学意义(,P,<,0.05)。单因素及多因素logistic回归分析显示，年龄、SOFA评分、ARDS来源、NLR、L/A为影响ARDS预后的独立危险因素(,P,<,0.05)。ROC曲线分析显示，年龄、SOFA评分、ARDS来源、NLR、L/A预测ARDS患者28 d预后的曲线下面积(AUC)分别为0.651、0.777、0.579、0.727、0.753，而ARDS来源联合年龄、SOFA评分的AUC为0.830，明显高于年龄(,P,=0.000)及ARDS来源(,P,=0.000)，但与SOFA评分比较差异无统计学意义(,P,=0.064)。将logistic回归筛选的5个危险因素构建列线图模型，定义为模型1，将年龄、ARDS来源、SOFA三个指标联合构建的模型定义为模型2。模型1预测ARDS预后的能力更高(AUC：0.889 ,vs., 0.830)，且校准曲线、决策曲线分析显示，模型1在ARDS患者预后预测方面具有较高的准确度及净效益值。,结论,2,L/A联合NLR构建的列线图可预测ARDS患者的早期预后，且具有较高的预测效能及临床获益。
Abstract
Objective,2,To investigate the value of nomogram based on lactate-to-albumin ratio (L/A) combined with neutrophil-to-lymphocyte ratio (NLR) for predicting the early prognosis of patients with acute respiratory distress syndrome (ARDS).,Methods,2,A total of 115 patients with ARDS admitted in the Department of Critical Care Medicine of the Second Hospital of Lanzhou University from March 2018 to June 2022 were retrospectively analyzed, and divided into survival group (,n,=62) and death group (,n,=53) depending on their clinical outcomes at 28 days after treatment. The general clinical data, blood routine, serum albumin, blood gas analysis, sequential organ failure (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Murray lung injury (Murray) score, number of organ failure, cause of ARDS, ICU stay, mechanical ventilation time, 28-day mortality were collected within 24 hours of ICU admission. At the same time, the L/A and NLR were calculated. Univariate and multivariate logistic regression analysis were performed to screen the independent risk factors affecting the prognosis of ARDS and to construct a clinical prediction model. The nomogram was drawn to visualize the clinical model. Finally, receiver operating characteristic (ROC) curve and calibration curve were used to verify the accuracy of the nomogram, a decision curve analysis was also performed to evaluate the clinical usefulness of the nomogram.,Results,2,The age, APACHE II, SOFA, and Murray scores, number of organ failure, proportion of pulmonary ARDS, neutrophil count (NEU), NLR, L/A, and blood lactate level in death group were significantly higher than those in survival group, the oxygenation index (PaO,2,/FiO,2,), proportion of extra pulmonary ARDS, lymphocyte count (LYM), and platelet count (PLT) were significantly lower than those in survival group (,P,<,0.05). Univariate analysis and multivariate logistic regression analysis showed that age, SOFA score, the cause of ARDS, NLR and L/A were the independent risk factors for prognosis of ARDS (,P,<,0.05). In addition, ROC curve analysis showed that the area under the ROC curve (AUC) of age, SOFA score, cause of ARDS, NLR and L/A in predicting the 28-day prognosis of ARDS patients were 0.651, 0.777, 0.579, 0.727 and 0.753, respectively. But the AUC of ARDS cause combined with age and SOFA score was 0.830, which was significantly higher than that of age (,P,=0.000) and ARDS cause (,P,=0.000), but there was no significant difference in SOFA score,(,P,=0.064). The nomogram based on all these five independent risk factors was constructed, which was defined as Model 1. At the same time, the combined model constructed by age, cause of ARDS and SOFA was defined as Model 2. The ROC comparison between the two showed that Model 1 had a higher ability to predict the prognosis of ARDS (AUC: 0.889 ,vs., 0.830), and the calibration curve and decision curve analysis showed that Model 1 had better accuracy and potential application value in predicting the prognosis of ARDS patients.,Conclusion,2,The nomogram constructed based on L/A combined with NLR can predict the early prognosis of patients with ARDS, and has high predictive efficiency and clinical benefit.
关键词
乳酸/白蛋白比值中性粒细胞/淋巴细胞比值列线图急性呼吸窘迫综合征
Keywords
lactate-to-albumin rationeutrophil-to-lymphocyte rationomogramacute respiratory distress syndrome
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