作者：刘晓敏1，2 ，张倩倩1，2 ，陶红艳1 ，第伍丹琲1 ，王丹1 ，万毅新1

单位：

1.730030甘肃省兰州市，兰州大学第二医院呼吸科　2.730030甘肃省兰州市，兰州大学第二临床医学院

Units：

1.Department of Respiratory, the Second Hospital of Lanzhou University, Lanzhou 730030, China 2.The Second Clinical Medical College of Lanzhou University, Lanzhou 730030, China

关键词：

　肺疾病，慢性阻塞性；重症监护病房；血尿素氮；清蛋白；血尿素氮与清蛋白比值；死亡；预测

Keywords：

Pulmonary disease, chronic obstructive; Intensive care units; Blood urea nitrogen; Albumins; Blood urea nitrogen/albumins; Death; Forecasting

CLC：

R 563.9

DOI：

10.12114/j.issn.1008-5971.2024.00.033

Funds：

甘肃省科技计划项目（21JR7RA401）

摘要：

目的　探讨血尿素氮与清蛋白比值（B/A）对慢性阻塞性肺疾病（COPD）患者重症监护室（ICU）内 及出院后30 d内死亡的预测价值。方法　2023年5—7月选取重症医学数据库Ⅳ（MIMIC-Ⅳ）2.0版中首次入住ICU且主 要诊断为COPD的患者，提取其临床资料，采用多因素Cox比例风险回归分析探讨COPD患者ICU内及出院后30 d内死亡 的影响因素；采用ROC曲线分析血尿素氮、清蛋白、B/A对COPD患者ICU内及出院后30 d内死亡的预测价值。结果　 共纳入993例COPD患者，其中185例（18.6%）患者ICU内死亡，230例（23.2%）患者出院后30 d内死亡。ICU内存活与 死亡者、出院后30 d内存活与死亡者年龄、男性占比、合并呼吸衰竭者占比、合并肾衰竭者占比、简化急性生理学评 分Ⅱ（SAPSⅡ）、序贯器官衰竭评估（SOFA）评分、急性生理学评分Ⅲ（APSⅢ）、全身炎症反应综合征（SIRS） 评分、牛津急性疾病严重程度评分（OASIS）、血钾、血肌酐、白细胞计数、血尿素氮、清蛋白、B/A、使用抗生素 者占比比较，差异有统计学意义（P＜0.05）。多因素Cox比例风险回归分析结果显示，年龄、性别、呼吸衰竭、肾 衰竭、SAPSⅡ、SOFA评分、APSⅢ、SIRS评分、OASIS、血钾、血肌酐、白细胞计数、血尿素氮、清蛋白、B/A、 使用抗生素是COPD患者ICU内死亡的独立影响因素（P＜0.05）；年龄、呼吸衰竭、肾衰竭、SAPSⅡ、SOFA评分、 APSⅢ、SIRS评分、OASIS、血钾、白细胞计数、血尿素氮、清蛋白、B/A、使用抗生素是COPD患者出院后30 d内死亡 的独立影响因素（P＜0.05）。ROC曲线分析结果显示，血尿素氮、清蛋白、B/A预测COPD患者ICU内死亡的AUC分别 为0.698、0.690、0.742，B/A预测COPD患者ICU内死亡的AUC大于血尿素氮、清蛋白预测COPD患者ICU内死亡的AUC （P＜0.05）；血尿素氮、清蛋白、B/A预测COPD患者出院后30 d内死亡的AUC分别为0.674、0.669、0.713，B/A预测 COPD患者出院后30 d内死亡的AUC大于血尿素氮、清蛋白预测COPD患者出院后30 d内死亡的AUC（P＜0.05）。结论 B/A是COPD患者ICU内及出院后30 d内死亡的独立影响因素，且其对COPD患者ICU内及出院后30 d内死亡有一定预测 价值。

Abstract：

Objective To explore the predictive value of blood urea nitrogen/albumins (B/A) for death in intensive care unit (ICU) and within 30 days after discharge in patients with chronic obstructive pulmonary disease (COPD) . Methods From May to July 2023, patients admitted to the ICU for the first time and were primarily diagnosed with COPD from the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) version 2.0 were selected. The clinical data of the patients were collected. Multivariate Cox proportional risk regression analysis was used to explore the influencing factors of death in ICU and within 30 days after discharge in patients with COPD. The ROC curve was used to explore the predictive value of blood urea nitrogen, albumins, B/A for death in ICU and within 30 days after discharge in patients with COPD. Results A total of 993 COPD patients were enrolled, of which 185 (18.6%) patients died in ICU and 230 (23.2%) patients died within 30 days after discharge. There were significant differences in age, proportion of males, proportion of patients with respiratory failure, proportion of patients with renal failure, Simplified Acute Physiology Score Ⅱ (SAPSⅡ) , Sequential Organ Failure Assessment (SOFA) score, Autoimmune Polyglandular Syndrome type Ⅲ (APSⅢ) , systemic inflammatory response syndrome (SIRS) score, Oxford Acute Severity of Illness Score (OASIS) , blood potassium, blood creatinine, white blood cell count, blood urea nitrogen, albumins, B/A, and proportion of patients using antibiotics between the patients survived and died in ICU and between the patients survived and died within 30 days after discharge (P < 0.05) . Multivariate Cox proportional risk regression analysis showed that age, gender, respiratory failure, renal failure, SAPSⅡ, SOFA score, APSⅢ, SIRS score, OASIS, blood potassium, blood creatinine, white blood cell count, blood urea nitrogen, albumins, B/A, and using antibiotics were the independent influencing factors of death in ICU in patients with COPD (P < 0.05) ; age, respiratory failure, renal failure, SAPSⅡ, SOFA score, APSⅢ, SIRS score, OASIS, blood potassium, white blood cell count, blood urea nitrogen, albumins, B/A, and using antibiotics were the independent influencing factors of prognosis within 30 days after discharge in patients with COPD (P < 0.05) . ROC curve analysis showed that the AUC of the blood urea nitrogen, albumins, B/A for predicting death in ICU in patients with COPD were 0.698, 0.690, 0.742, respectively, the AUC of the B/A for predicting death in ICU in patients with COPD was higher than the AUC of the blood urea nitrogen, albumins for predicting death in ICU in patients with COPD (P < 0.05) , the AUC of the blood urea nitrogen, albumins, B/A for predicting death within 30 days after discharge in patients with COPD were 0.674, 0.669, 0.713, respectively, the AUC of the B/A for predicting death within 30 days after discharge in patients with COPD was higher than the AUC of the blood urea nitrogen, albumins for predicting death within 30 days after discharge in patients with COPD (P < 0.05) . Conclusion B/A is an independent influencing factor of death in ICU and within 30 days after discharge in patients with COPD, and it has certain predictive value for the death in ICU and within 30 days after discharge in patients with COPD.

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