微量白蛋白尿对脓毒症早期诊断及预后价值

摘要

目的 研究危重症患者微量白蛋白尿(MA)能否早期诊断脓毒症及评估其预后.方法 2013年1月至2014年12月入住本院ICU 206例危重症患者入选本研究,分别检测入ICU时尿白蛋白肌酐比值(ACR1)、乳酸(LAC1)及入ICU 6 h时ACR(ACR2)、乳酸(LAC2)等,追踪28 d病死率.比较脓毒症与非脓毒症ACR1,应用受试者工作特征(ROC)曲线测定ACR1对脓毒症诊断界值,应用Logistic回归分析脓毒症28 d病死的独立危险因素.结果 脓毒症组ACR1显著高于非脓毒症组(P＜0.01),ROC曲线分析提示ACR1诊断脓毒症界值为105 mg/g.脓毒症组28 d死亡患者ACR2显著高于生存者(P＜0.01).ACR2与LAC2是脓毒症患者28 d病死的独立危险因素(P＜0.01),两者死亡预测价值无统计学差异(P＞0.05).结论 入ICU时MA升高可能提示脓毒症.入ICU 6 h时MA与乳酸升高可能是脓毒症28 d病死的独立危险因素.%Objective To study the early diagnostic and prognostic value of microalbuminuria (MA) in patients with sepsis.Methods A total of 206 critically ill patients from January 2013 to December 2014 in ICU of our hospital were enrolled in the study.Urinary albumin to creatinine ratio (ACR1) and lactic acid (LAC1) were detected on admission of ICU.ACR2 and LAC2 were detected after 6 hours.28 days mortality rate was tracked.ACR1 was compared between patients with sepsis and without sepsis.The diagnostic value of ACR1 on sepsis was measured by receiver operating characteristic (ROC) curve.The independent risk factors of death within 28 days of sepsis were analyzed by Logistic regression analysis.Results ACR1 in sepsis group was significantly higher than that in non sepsis group (P＜0.01).ROC curve showed that the diagnostic value of ACR1 on sepsis was 105 mg/g.ACR2 in dead patients was significantly higher than that in survivors in sepsis group after 28 d (P＜0.01).ACR2 and LAC2 were independent risk factors of death within 28 days in patients with sepsis (P＜0.01),without statistically significant difference between two index (P＞0.05).Conclusions High value of MA may indicate sepsis on admission of ICU.ACR and lactate acid after 6 h in ICU were independent risk factors of death within 28 days in patients with sepsis.