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| 血浆氨基末端脑钠肽前体浓度与老年髋部骨折危重患者术后结局的相关性 |
| Correlation between plasma NT-proBNP level and postoperative outcomes in elderly and critically ill patients with hip fractures |
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| DOI：10.12089/jca.2024.01.004 |
| 中文关键词: 老年 危重 髋部骨折 血浆氨基末端脑钠肽前体 死亡率 |
| 英文关键词: Aged Critically ill Hip fracture N-terminal pro-B-type natriuretic peptidogen Mortality |
| 基金项目:北京积水潭医院高层次人才“学科骨干”培养计划（XKGG202116） |
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| 中文摘要: |
目的：探讨术前血浆氨基末端脑钠肽前体（NT-proBNP）浓度与老年髋部骨折危重患者术后结局的相关性。
方法：选择2018年1月至2021年4月老年髋部骨折危重患者593例，男189例，女404例，年龄≥65岁，BMI 12.0～35.5 kg/m2，ASA Ⅱ—Ⅳ级。通过电子病历系统和电话随访收集术前一般情况、术中及术后情况。绘制术前NT-proBNP浓度与术后30 d死亡情况的受试者工作特征（ROC）曲线，得到NT-proBNP临界值为1 765.0 pg/ml。根据患者术前血浆NT-proBNP浓度分为两组：低浓度组（NT-proBNP≤1 765.0 pg/ml，L组，n=463）和高浓度组（NT-proBNP>1 765.0 pg/ml，H组，n=130）。采用单因素和多因素Logistic回归分析术前不同血浆浓度NT-proBNP与术后ICU时间、总住院时间、术后并发症和死亡率之间的相关性。
结果：与L组比较，H组年龄、术前合并冠心病、心律失常、慢性心功能不全、肺部疾病和慢性肾脏疾病的比例、术后30 d内死亡率明显升高（P<0.05）。多因素Logistic回归分析显示，术前血浆高浓度NT-proBNP与术后ICU时间（OR=1.215， 95%CI 1.073～1.375， P=0.020）、术后30 d死亡（OR=32.696， 95%CI 7.158～149.338，P<0.001）呈明显正相关关系。
结论：术前血浆高浓度NT-proBNP与术后ICU时间、术后30 d死亡呈正相关。 |
| 英文摘要: |
Objective: To investigate the correlation between preoperative N-terminal pro-B-type natriuretic peptidogen (NT-proBNP) levels and early postoperative outcomes in elderly and critically ill patients with hip fractures.
Methods: A total of 593 elderly and critically ill patients with hip fractures from January 2018 to April 2021 were selected, including 189 males and 404 females, aged ≥65 years, BMI 12.0-35.5 kg/m2, ASA physical status Ⅱ-Ⅳ. General preoperative information, intraoperative and postoperative discharge outcomes of patients were retrospectively obtained by the electrical clinical medical record system or telephone follow-up. The receiver operator characteristic (ROC) curve of preoperative plasma NT-proBNP and postoperative 30-day death was plotted, and the corresponding optimal cut-off value was 1 765.0 pg/ml. According to NT-proBNP values, the patients were divided into two groups: low-ratio group (NT-proBNP ≤ 1 765.0 pg/ml, group L, n = 463) and high-ratio group (NT-proBNP > 1 765.0 pg/ml, group H, n = 130). The correlation between different plasma concentrations of NT-proBNP before surgery and ICU length of stay, total length of stay, postoperative complications, and 30-day mortality rate were analyzed using univariate and multivariate logistic regression analysis.
Results: Compared with group L, age, preoperative comorbidities with coronary heart disease, arrhythmia, chronic heart failure, lung disease, and chronic kidney disease, as well as mortality within 30 days after surgery were significantly increased in group H (P < 0.05). The multivariate logistic regression analysis showed that high preoperative plasma NT-proBNP concentration was positive correlation with postoperative ICU length of stay (OR = 1.215, 95% CI 1.073-1.375, P = 0.020) and 30-day mortality rate (OR = 32.696, 95% CI 7.158-149.338, P < 0.001).
Conclusion: High preoperative plasma NT-proBNP concentration is positive correlation with postoperative ICU hospitalization time and 30-day mortality. |
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