| 白蛋白校正阴离子间隙与肝衰竭患者预后的关系 |
| 投稿时间：2025-06-27 修订日期：2025-08-06 点此下载全文 |
| 引用本文：冉林蔚,张志伟,姚添,杨泓,史志勇.白蛋白校正阴离子间隙与肝衰竭患者预后的关系[J].医学研究杂志,2025,54(12):112-116, 133 |
| DOI：
10.11969/j.issn.1673-548X.2025.12.019 |
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| 基金项目:山西省自然科学研究面上项目(202403021221285) |
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| 中文摘要:目的 探讨白蛋白校正阴离子间隙(albumin-corrected anion gap,ACAG)与肝衰竭患者28天死亡率之间的关联。方法 回顾性分析MIMIC-Ⅳ数据库中2008~2022年符合肝衰竭诊断标准的成年肝衰竭患者的临床资料,根据入院后28天生存情况将其分为生存组(n=975)和死亡组(n=614)；根据ACAG水平分为低ACAG组(12~20mmol/L)和高ACAG组(>20mmol/L)。通过多因素COX回归分析、Kaplan-Meier生存曲线、限制性立方样条(restricted cubic splines,RCS)以及亚组分析评估ACAG与肝衰竭患者28天全因死亡率的相关性。结果 共纳入1589例患者,28天全因死亡率为38.64%。高ACAG组患者的死亡率显著高于低ACAG组(χ2=38.099,P<0.001)。ACAG是肝衰竭患者28天全因死亡率的独立危险因素,且与死亡率呈非线性关联(Pnonlinear=0.014),阈值为19.5mmol/L。当ACAG水平<19.5mmol/L时,肝衰竭患者的死亡风险显著升高(HR=1.145,95% CI:1.087~1.207)；而ACAG水平≥19.5mmol/L时,肝衰竭患者的死亡风险增幅减缓(HR=1.048,95% CI:1.025~1.071)。亚组分析提示该结果稳定。结论 ACAG与肝衰竭患者28天全因死亡率显著相关,是其短期不良预后的独立危险因素。 |
| 中文关键词:白蛋白校正阴离子间隙 肝衰竭 预后 MIMIC-Ⅳ数据库 |
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| Relationship between Albumin-corrected Anion Gap and Prognosis in Patients with Liver Failure. |
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| Abstract:Objective To investigate the relationship between albumin-corrected anion gap (ACAG) and the prognosis of patients with liver failure. Methods The clinical data of adult patients with liver failure who met the diagnostic criteria for liver failure in MIMIC-IV database from 2008 to 2022 was retrospectively analyzed. Patients were divided into the survival group (n=975) and the death group (n=614) according to the 28-day survival situation after admission. According to the ACAG level, they were divided into the low ACAG group (12-20mmol/L) and the high ACAG group (>20mmol/L). The correlation between ACAG and 28-day all-cause mortality in patients with liver failure was evaluated using multivariate COX regression analysis, Kaplan-Meier survival curve, restricted cubic splines (RCS) and subgroup analysis. Results A total of 1589 patients were included, with a 28-day all-cause mortality rate of 38.64%. The mortality of patients in the high ACAG group was significantly higher than that in the low ACAG group (χ2=38.099, P<0.001). ACAG was an independent risk factor for 28-day all-cause mortality in patients with liver failure, and exhibited a nonlinear association with mortality (Pnonlinear=0.014), with a threshold of 19.5mmol/L. When ACAG < 19.5mmol/L, the risk of death in patients with liver cancer was significantly increased (HR=1.145,95% CI:1.087-1.207); When ACAG ≥19.5mmol/L, the increase in the risk of death for patients with liver cancer slowed down (HR=1.048,95% CI:1.025-1.071). Subgroup analyses yielded consistent results. Conclusion ACAG is significantly associated with 28-day all-cause mortality in patients with liver failure, and is an independent risk factor of short-term poor prognosis. |
| keywords:Albumin-corrected anion gap Liver failure Prognosis MIMIC-IV database |
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