乳酸脱氢酶与白蛋白比值对脓毒症相关急性肾损伤患者短期预后的影响

doi:10.3969/j.issn.1006-5725.2024.13.007

Abstract

Abstract:

Objective To explore the relationship between lactate dehydrogenase to albumin ratio （LAR） and short?term prognosis in patients with sepsis?associated acute kidney injury （AKI）. Methods A retrospective analysis was conducted on 463 sepsis patients treated in the intensive care unit （ICU） of Beijing Shijitan Hospital， Capital Medical University， from January 2018 to June 2022. The patients were divided into two groups： a group with secondary AKI （AKI group） and the one without acute kidney injury （non?AKI group）. Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEⅡ）， Sequential Organ Failure Assessment （SOFA）， and levels of procalcitonin （PCT）， C?reactive protein （CRP）， serum creatinine （SCr）， lactate dehydrogenase （LDH）， and albumin （ALB） were compared between the two groups. Multivariate logistic regression analysis was used to determine prognostic factors for sepsis?associated acute kidney injury， and Receiver Operating Characteristic （ROC） analysis was performed to assess the predictive value of APACHE Ⅱ score， SOFA score， PCT， SCr， and lactate dehydrogenase to albumin ratio （LAR） for short?term prognosis of sepsis?associated acute kidney injury. Results The 28?day mortality rate in the non?AKI group was lower than that in the AKI group， and the length of stay in ICU was shorter in the non?AKI group than in the AKI group （P < 0.05）. APACHE Ⅱ score， SOFA score， PCT， SCr and LAR were independent influencing factors for 28?days death in patients with sepsis?associated acute kidney injury. The ROC curve analysis showed that LAR level had a higher predictive value for short?term prognosis in patients with sepsis?associated AKI as compared with APACHE Ⅱ score， SOFA score， PCT， and SCr. Conclusions LAR is an independent risk factor for sepsis?associated AKI and is associated with 28?day mortality in patients.

Key words: sepsis, acute kidney injury, lactate dehydrogenase, albumin

CLC Number:

R563.1

Guomin ZHAO,Hui ZHANG,Pucong YE,Wei. CHEN. Effect of lactate dehydrogenase to albumin ratio on the short⁃term prognosis in patients with sepsis⁃associated acute kidney injury[J]. The Journal of Practical Medicine, 2024, 40(13): 1803-1807.

Figures/Tables 5

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References 23

1	SINGER M， DEUTSCHMAN C S， SEYMOUR C W， et al. The Third International Consensus Definitions for Sepsis and Septic Shock （Sepsis-3）［J］. JAMA， 2016，315（8）：801-810. doi:10.1001/jama.2016.0287 doi: 10.1001/jama.2016.0287
2	RUDD K E， JOHNSON S C， AGESA K M， et al. Global， regional， and national sepsis incidence and mortality， 1990-2017： analysis for the Global Burden of Disease Study［J］. Lancet， 2020，395（10219）：200-211. doi:10.1016/s0140-6736(19)32989-7 doi: 10.1016/s0140-6736(19)32989-7
3	PEERAPORNRATANA S， MANRIQUE-CABALLERO C L， GÓMEZ H， et al. Acute. kidney injury from sepsis： current concepts， epidemiology， pathophysiology， prevention and treatment［J］. Kidney Int， 2019，96（5）：1083-1099. doi:10.1016/j.kint.2019.05.026 doi: 10.1016/j.kint.2019.05.026
4	张磊，江巍，郑玉雯，等. 新型冠状病毒肺炎严重程度危险因素的分析［J］. 实用医学杂志， 2020，36（14）：1866-1871.
5	刘蓉，于智彩，尚长雪，等. 不同方法对中国西南地区儿童重症监护病房脓毒症病死率的预测价值［J］. 中华儿科杂志， 2024，62（3）： 204-210. doi:10.3760/cma.j.cn112140-20231013-00282 doi: 10.3760/cma.j.cn112140-20231013-00282
6	CHEBL R BOU， JAMALI S， SABRA M， et al. Lactate/Albumin Ratio as a Predictor of In-Hospital Mortality in Septic Patients Presenting to the Emergency Department［J］. Front Med （Lausanne）， 2020， 7：550182. Published 2020 Sep 22. doi:10.3389/fmed.2020.550182 doi: 10.3389/fmed.2020.550182
7	DeNG S， GAO J， ZHAO Z， et al. Albumin/Procalcitonin Ratio Is a Sensitive Early Marker of Nosocomial Blood Stream Infection in Patients with Intra-Cerebral Hemorrhage［J］. Surg Infect （Larchmt）， 2019， 20（8）：643-649. doi:10.1089/sur.2018.260 doi: 10.1089/sur.2018.260
8	FENG D Y， ZHOU Y Q， ZOU X L， et al. Elevated Blood Urea Nitrogen-to-Serum Albumin Ratio as a Factor That Negatively Affects the Mortality of Patients with Hospital-Acquired Pneumonia［J］. Can J Infect Dis Med Microbiol， 2019， 2019：1547405. doi:10.1155/2019/1547405 doi: 10.1155/2019/1547405
9	KHWAJA A. KDIGO clinical practice guidelines for acute kidney injury［J］. Nephron Clin Pract， 2012， 120：179-184. doi:10.1159/000339789 doi: 10.1159/000339789
10	TAKEGAWA R， KABATA D， SHIMIZU K， et al. Serum albumin as a risk factor for death in patients with prolonged sepsis： An observational study［J］. J Crit Care， 2019， 51：139-144. doi:10.1016/j.jcrc.2019.02.004 doi: 10.1016/j.jcrc.2019.02.004
11	LUNA C M， PERÍN M M. Can lactate dehydrogenase （LDH） be used as a marker of severity of pneumonia in patients with renal transplant？［J］. Ann Transl Med， 2020， 8（15）：911. doi:10.21037/atm-2020-34 doi: 10.21037/atm-2020-34
12	ZHANG D， SHI L. Serum lactate dehydrogenase level is associated with in-hospital mortality in critically Ill patients with acute kidney injury［J］. Int Urol Nephrol， 2021， 53（11）：2341-2348. doi:10.1007/s11255-021-02792-z doi: 10.1007/s11255-021-02792-z
13	QIAO J， CUI L. Multi-Omics Techniques Make it Possible to Analyze Sepsis-Associated Acute Kidney Injury Comprehensively［J］. Front Immunol， 2022， 13：905601. doi:10.3389/fimmu.2022.905601 doi: 10.3389/fimmu.2022.905601
14	PATIL N K， PARAJULI N， MACMILLAN-CROW L A， et al. Inactivation of renal mitochondrial respiratory complexes and manganese superoxide dismutase during sepsis： mitochondria-targeted antioxidant mitigates injury［J］. Am J Physiol Renal Physiol， 2014，306（7）： F734-F743. doi:10.1152/ajprenal.00643.2013 doi: 10.1152/ajprenal.00643.2013
15	GOMEZ H， INCE C， DE BACKER D， et al. A unified theory of sepsis-induced acute kidney injury： inflammation， microcirculatory dysfunction， bioenergetics， and the tubular cell adaptation to injury［J］. Shock， 2014，41（1）：3-11. doi:10.1097/shk.0000000000000052 doi: 10.1097/shk.0000000000000052
16	蒋芬，文南萍，莫红艳，等. 中性粒细胞/淋巴细胞比值在重症患者急性肾损伤的应用价值［J］. 实用医学杂志， 2020，36（21）：2958-2961. doi:10.3969/j.issn.1006-5725.2020.21.014 doi: 10.3969/j.issn.1006-5725.2020.21.014
17	WU N， LIU T， TIAN M， et al. Albumin， an interesting and functionally diverse protein， varies from 'native' to 'effective' （Review）［J］. Mol Med Rep， 2023， 29（2）： 24. doi:10.3892/mmr.2023.13147 doi: 10.3892/mmr.2023.13147
18	LIANG M， REN X， HUANG D， et al. The association between lactate dehydrogenase to serum albumin ratio and the 28-day mortality in patients with sepsis-associated acute kidney injury in intensive care： a retrospective cohort study［J］. Ren Fail， 2023，45（1）：2212080. doi:10.1080/0886022x.2023.2212080 doi: 10.1080/0886022x.2023.2212080
19	白瑜，于锐，田密，等. 白蛋白对肾小管上皮细胞转分化的影响及其分子机制［J］. 山东医药， 2020，60（35）：22-25. doi:10.3969/j.issn.1002-266X.2020.35.005 doi: 10.3969/j.issn.1002-266X.2020.35.005
20	马娜，金雨舟，刘福菁，等. 乳酸脱氢酶白蛋白比值对重症肺炎患者并发弥散性血管内凝血的预测价值［J］. 中国呼吸与危重监护杂志， 2023，22（12）：845-851. doi:10.7507/1671-6205.202308059 doi: 10.7507/1671-6205.202308059
21	LUNA C M， PERÍN M M. Can lactate dehydrogenase （LDH） be used as a marker of severity of pneumonia in patients with renal transplant？［J］. Ann Transl Med， 2020， 8（15）： 911. doi:10.21037/atm-2020-34 doi: 10.21037/atm-2020-34
22	FENG J F， WANG L， YANG X， et al. Prognostic value of lactate. dehydrogenase to albumin ratio （LAR） in patients with resectable esophageal squamous cell carcinoma［J］. Cancer Manag Res， 2019， 11：7243-7251. doi:10.2147/cmar.s208320 doi: 10.2147/cmar.s208320
23	JEON S Y， RYU S， OH S K， et al. Lactate dehydrogenase to albumin ratio as a prognostic factor for patients with severe infection requiring intensive care［J］. Medicine （Baltimore）， 2021，100（41）： e27538. doi:10.1097/md.0000000000027538 doi: 10.1097/md.0000000000027538

项目	Non-AKI 组	AKI 组	t/χ²/Z值	P值
例数	312	151
年龄（x ± s，岁）	69.97 ± 7.13	70.40 ± 7.82	0.565	0.572
男［例（%）］	175（56.09）	88（58.28）	0.199	0.656
体质量指数（x ± s，kg/m²）	22.28 ± 2.83	21.94 ± 2.30	1.384	0.167
APACHEⅡ［M（P₂₅，P₇₅），分］	13（11，16.75）	16（12，19）	-3.800	< 0.001
SOFA［M（P₂₅，P₇₅），分］	7（5，9）	8（7，10）	-5.187	< 0.001
基础病［例（%）］
高血压	132（42.31）	68（45.03）	0.308	0.579
冠心病	141（45.19）	70（46.36）	0.056	0.813
糖尿病	123（39.42）	69（45.69）	1.649	0.199
慢性阻塞性肺疾病	145（46.47）	61（40.39）	1.522	0.217
脑血管病	123（39.42）	63（41.72）	0.224	0.636
感染部位［例（%）］
肺	161（51.60）	66（43.71）	2.537	0.111
腹部	63（20.19）	31（20.53）	0.007	0.933
胃肠道	42（13.46）	19（12.58）	0.069	0.793
皮肤/软组织	36（11.54）	27（17.88）	3.482	0.062
其他部位	10（3.21）	8（5.30）	1.193	0.275
临床指标
PCT［M（P₂₅，P₇₅），ng/mL］	0.94（0.31，3.23）	1.27（0.47，2.53）	-2.144	0.032
SCr［M（P₂₅，P₇₅），μmol/L］	175.67（87.56，187.93）	208.23（117.54，218.52）	-4.781	< 0.001
CRP［M（P₂₅，P₇₅），mg/L］	94.62（45.21，1470.97）	97.30（60.63，148.88）	-1.154	0.111
LDH［M（P₂₅，P₇₅），U/L］	279.0（212.0，362.0）	291.0（232.0，447.0）	-0.936	0.350
ALB［M（P₂₅，P₇₅），g/L］	33.6（29.9，38.0）	29.1（27.0，31.3）	-2.747	0.006
LAR［M（P₂₅，P₇₅）］	8.31（6.09，9.99）	8.88（7.26，11.20）	-3.805	< 0.001
临床结局
连续性肾脏替代治疗［例（%）］	185（59.29）	89（58.94）	1.148	0.284
28 d病死率［例（%）］	77（24.68）	54（35.76）	6.160	0.013
ICH住院时间［M（P₂₅，P₇₅），d］	8.36 ± 2.47	9.15 ± 3.89	2.262	0.025

项目	β	SE	Wald χ²	P值	OR	95%CI
APACHEⅡ评分	0.391	0.041	89.657	0.000	1.479	1.364 ~ 1.603
SOFA评分	0.129	0.054	5.795	0.016	1.314	1.186 ~ 1.257
PCT	0.157	0.065	5.593	0.020	1.149	1.008 ~ 1.290
SCr	0.078	0.031	6.791	0.016	1.076	1.013 ~ 1.139
ALB	-0.025	0.013	3.701	0.054	0.976	0.951 ~ 1.000
LAR	0.030	0.009	11.034	0.001	1.031	1.012 ~ 1.049

项目	AUC	95%CI	截断值	敏感度（%）	特意度（%）
APACHEⅡ评分	0.762	0.582 ~ 0.613	13.5	70.3	67.4
SOFA评分	0.655	0.826 ~ 0.909	8.5	65.3	70.0
PCT	0.615	0.557 ~ 0.674	3.03	61.2	59.3
SCr	0.803	0.759 ~ 0.846	156.72	66.4	64.8
LAR	0.819	0.772 ~ 0.867	9.3	70.9	73.8

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Effect of lactate dehydrogenase to albumin ratio on the short⁃term prognosis in patients with sepsis⁃associated acute kidney injury

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