| C反应蛋白与白蛋白比值在脓毒症性凝血病诊断及预后评估中的应用价值 |
| 投稿时间：2025-03-14 修订日期：2025-03-29 点此下载全文 |
| 引用本文：李晨,刘军.C反应蛋白与白蛋白比值在脓毒症性凝血病诊断及预后评估中的应用价值[J].医学研究杂志,2025,54(8):114-120 |
| DOI：
10.11969/j.issn.1673-548X.2025.08.019 |
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| 基金项目:江苏省社会发展面上项目(BE2021660) |
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| 中文摘要:目的 探讨C反应蛋白与白蛋白比值(c-reactive protein-to-albumin ratio,CAR)对脓毒症患者发生脓毒症性凝血病(sepsis-induced coagulopathy,SIC)的影响,以及对SIC患者28天预后的预测价值。方法 回顾性分析2023年4月～2024年5月南京医科大学附属苏州医院收治的142例脓毒症患者的临床资料。采用多因素Logistic回归分析和受试者工作特征(receiver operating characteristic,ROC)曲线评价CAR对SIC发生及28天预后的预测价值,获取截断值,分析不同CAR水平对SIC发生及死亡风险的影响。结果 142例脓毒症患者,平均年龄为76.10±12.32岁,序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分为8.00 (5.00,10.00)分；其中男性105例(73.9%)。最常见的感染部位为肺部感染[106例(74.6%)],其中SIC组64例(45.1%),非SIC组78例(54.9%)。与非SIC组比较, SIC组患者CAR显著升高[4.10 (2.19,6.03) vs 1.85 (0.58,4.22),P<0.05]；多因素Logistic回归分析结果显示,CAR升高是脓毒症患者发生SIC的独立危险因素(OR=1.224,95%CI:1.042~1.437,P＜0.05)；血乳酸(lactic acid,Lac)和血小板计数(platelet,PLT)也是脓毒症患者发生SIC的独立危险因素。与存活组比较,死亡组的CAR显著升高[5.29 (3.27,6.51) vs 2.70 (1.24,4.87),P<0.01]；多因素Logistic回归分析结果显示,CAR升高是SIC患者28天死亡的独立危险因素(OR=1.291,95%CI:1.042~1.600,P＜0.05)。ROC曲线分析结果显示,CAR预测SIC发生的ROC曲线的曲线下面积(area under the curve,AUC)为0.691(95%CI:0.605～0.777),最佳截断值为2.54,对应的特异性、敏感度和约登指数分别为61.0%、73.0%和0.349；CAR预测SIC患者28天死亡的AUC为0.718(95%CI:0.590～0.846),最佳截断值为3.83,对应的特异性、敏感度和约登指数分别为72.0%、71.0%和0.438。当CAR＞2.54时,SIC的发生风险是CAR≤2.54的2.436倍(OR=2.436,95%CI:1.076~5.515,P＜0.05)；当CAR＞3.83时,SIC患者28天死亡的风险是CAR≤3.83患者的5.652倍(OR=5.652,95%CI:1.844~17.324,P＜0.05)。结论 CAR是脓毒症患者SIC发生及28天死亡的独立危险因素,具有良好的预测价值。 |
| 中文关键词:脓毒症性凝血病 C反应蛋白 白蛋白 危险因素 |
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| Application Value of C-reactive Protein-to-albumin Ratio in the Diagnosis and Prognosis Evaluation of Sepsis-induced Coagulopathy. |
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| Abstract:Objective To investigate the effect of C-reactive protein -to-albumin ratio (CAR) on sepsis-induced coagulopathy (SIC) in patients with sepsis, and the predictive value for the 28-day prognosis of patients with SIC. Methods The clinical data of 142 patients with sepsis admitted to the the Affiliated Suzhou Hospital of Nanjing Medical University from April 2023 to May 2024 were retrospectively analyzed. Multivariate Logistic regression analysis and receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive value of CAR for the occurrence of SIC and the 28-day prognosis, and the cut-off values were obtained, and the effects of different CAR on the occurrence and death risk of SIC were analyzed. Results There were142 patients with sepsis, aged 76.10±12.32 years, sequential organ failure assessment (SOFA) score was 8.00 (5.00,10.00) points. Among them, 105 (73.9%) werewas males. The most common site of infection was lung infection in 106 cases (74.6%), of which 64 cases (45.1%) were in SIC group, and 78 cases (54.9%) were in non-SIC group. Compared with non-SIC group, CAR in SIC group was significantly increased [4.10 (2.19,6.03) vs 1.85 (0.58,4.22), P<0.05]. Multivariate Logistic regression analysis showed that increased CAR was an independent risk factor for SIC in sepsis patients (OR=1.224,95%CI:1.042-1.437, P<0.05). lactic acid (Lac) and platelet (PLT) were also independent risk factors for SIC in sepsis patients. Compared with the survival group, CAR levels in the death group were significantly higher [5.29 (3.27,6.51) vs 2.70 (1.24,4.87), P<0.01]. Multivariate Logistic regression analysis showed that CAR elevation was an independent risk factor for 28-day death in SIC patients (OR=1.291,95%CI:1.042-1.600), P<0.05). ROC curve analysis showed that the area under the curve (AUC) of CAR for predicting the occurrence of SIC was 0.691 (95%CI:0.605-0.777), the optimal cut-off value was 2.54, and the corresponding specificity, sensitivity and Youden index were 61.0%, 73.0% and 0.349, respectively. The AUC of CAR in predicting 28-day death in patients with SIC was 0.718 (95%CI:0.590-0.846), the optimal cut-off value was 3.83, corresponding specificity, sensitivity and Youden index were 72.0%, 71.0% and 0.438, respectively. When CAR > 2.54, the risk of SIC was 2.436 times that of CAR≤2.54 (OR=2.436,95%CI:1.076-5.515, P<0.05). When CAR > 3.83, the risk of 28-day death in patients with SIC was 5.652 times that of patients with CAR≤3.83 (OR=5.652,95%CI:1.844-17.324, P<0.05). Conclusion CAR is an independent risk factor for the occurrence of SIC and 28-day death in patients with sepsis, showing good predictive value. |
| keywords:Sepsis-induced coagulopathy C-reactive protein Albumin Risk factor |
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