Prognostic value of C-reactive protein/albumin ratio in neurocritically ill patients
Prognostic value of C-reactive protein/albumin ratio in neurocritically ill patients
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C反应蛋白/白蛋白比值对神经危重症患者的预后价值
DOI：
10.23736/s0375-9393.19.13625-5
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发表时间：
2019-12-01
影响因子：
3.2
通讯作者：
Huang, Kaibin
中科院分区：
文献类型：
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作者：
Bai, Min;Wu, Yongming;Huang, Kaibin
背景：C反应蛋白（CRP）与白蛋白的比值已被视为癌症和脓毒症患者的预后预测指标。在本研究中，我们评估了CRP与白蛋白的比值对神经危重症患者的预后价值。
方法：我们回顾性分析了2013年1月至2017年1月期间一所大学附属医院神经重症监护病房（NCU）收治的连续患者。CRP与白蛋白的比值通过将NCU入院时测得的CRP水平除以白蛋白浓度得出。采用单变量和多变量逻辑回归分析来确定30天不良预后（改良Rankin量表评分4 - 6分）的危险因素。通过受试者工作特征（ROC）曲线分析进一步评估CRP与白蛋白比值的预测效能。
结果：纳入的701例患者中，398例（56.8%）在30天时有不良预后。不良预后组CRP与白蛋白比值的中位数（四分位数间距）（0.9 [0.2 - 2.5]）明显高于良好预后组（0.3 [0.1 - 1.2]）。在对已明确的预后指标进行校正后，CRP与白蛋白的比值（优势比1.205；95%置信区间：1.082 - 1.344）在预测30天不良预后方面仍具有显著意义，ROC曲线下面积为0.644，临界值为0.58。进一步探究显示，CRP与白蛋白比值的预后价值主要存在于脓毒性休克患者中（优势比1.616；95%置信区间：1.167 - 2.236），ROC曲线下面积为0.672，临界值为1.75。
结论：NCU入院时CRP与白蛋白比值较高是神经危重症患者30天不良预后的独立预测因素，尤其是在脓毒性休克患者中。
BACKGROUND: The C-reactive protein (CRP)/albumin ratio has been regarded as an outcome predictor in patients with cancer and sepsis. In this study we evaluated the prognostic value of the CRP/albumin ratio in neurocritically ill patients.METHODS: We retrospectively reviewed consecutive patients admitted to the neurocritical care unit (NCU) of a university-affiliated hospital, between January 2013 and January 2017. The CRP/albumin ratio was calculated by dividing the CRP level by the albumin concentration that was obtained at NCU admission. Univariablc and multivariable logistic regression were used to identify risk factors for 30-day unfavorable outcome (modified Rankin Scale of 4 to 6). The performance of the CRP/albumin ratio was further assessed by receiver operating characteristic (ROC) curve analysis.RESULTS: Of the 701 patients included, 398 (56.8%) had unfavorable outcome at 30 days. The median (interquartile range) value of the CRP/albumin ratio was noticeably higher in the unfavorable outcome group (0.9 [0.2-2.5]) than that in the favorable group (0.3 [0.1-1.2]). After adjustment for established prognostic markers of outcome, the CRP/albumin ratio (OR 1.205; 95 % CI: 1.082 1.344 ) remained significant in predicting 30-day unfavorable outcome, with an area under the ROC curve of 0.644 and a cutoff value of 0.58. Further exploration showed that the prognostic value of the CRP/albumin ratio existed mainly in patients suffering septic shock (OR 1.616; 95% CI: 1.167-2.236), with an area under the ROC curve of 0.672 and a cutoff value of 1.75.CONCLUSIONS: A high CRP/albumin ratio at NCU admission was an independent predictor of 30-day unfavorable outcome in neurocritically ill patients, especially in those suffering septic shock.