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| 白蛋白输注对脓毒症休克患者短期死亡率的影响：一项基于MIMIC-Ⅳ数据库的研究 |
| Effect of albumin infusion on short-term mortality in patients with septic shock: a study based on MIMIC-Ⅳ database |
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| DOI：10.12089/jca.2025.08.010 |
| 中文关键词: 脓毒症休克 白蛋白 液体复苏 死亡率 重症监护医疗信息市场Ⅳ数据库 |
| 英文关键词: Septic shock Albumin Fluid resuscitation Mortality Medical information mart for intensive care-Ⅳ database |
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| 中文摘要: |
目的： 探究脓毒症休克患者液体复苏早期输注白蛋白对短期死亡率的影响。
方法：通过重症监护医疗信息市场（MIMIC）-Ⅳ数据库筛选脓毒症休克患者2 697例，筛选标准为Sepsis 3.0标准。根据入ICU后24 h内的液体复苏早期是否接受白蛋白输注治疗，将脓毒症休克患者分为两组：白蛋白组(n=598)和非白蛋白组(n=2 099)。白蛋白组接受白蛋白输注及其他常规治疗；非白蛋白组不输注白蛋白，仅接受其他常规治疗。主要结局指标为入ICU后28 d死亡率，次要结局指标为入ICU后90 d死亡率。采用多因素Logistic回归分析评估脓毒症休克患者液体复苏早期输注白蛋白与死亡率的关系。
结果：多因素Logistic回归分析结果显示，与非白蛋白组比较，白蛋白组入ICU后28 d死亡率明显降低（OR=0.771，95%CI 0.618～0.961，P=0.021），两组入ICU后90 d死亡率差异无统计学意义（OR=0.852，95%CI 0.690～1.053，P=0.138）。亚组分析显示，与非白蛋白组比较，血乳酸<4.6 mmol/L（OR=0.681，95%CI 0.487～0.952，P=0.025）、血尿素氮<9.1 mmol/L（OR=0.677，95%CI 0.461～0.996，P=0.048）或SOFA<8.5分（OR=0.596，95%CI 0.383～0.925，P=0.021），白蛋白组入ICU后28 d死亡率明显降低。
结论：与不输注白蛋白比较，在脓毒症休克患者液体复苏早期输注白蛋白可降低入ICU后28 d死亡率，但90 d死亡率无显著差异。 |
| 英文摘要: |
Objective: To investigate the effect of early infusion of albumin during fluid resuscitation on the short-term mortality rate in patients with septic shock.
Methods: Cases with septic shock were screened through the medical information mart for intensive care (MIMIC)-Ⅳ database, and the screening criterion was Sepsis 3.0. Depending on whether they received albumin infusion within 24 hours after admission to ICU, they were divided into two groups: the albumin group (n = 598) and the non-albumin group (n = 2 699). The patients in the albumin group received albumin infusion and other conventional treatments, and the patients in the non-albumin group did not receive albumin infusion and only received other conventional treatments. The primary outcome was the 28-day mortality rate after admission to the ICU, and the secondary outcome was the 90-day mortality rate after admission to the ICU. A multivariate Logistic regression model was used to evaluate the association between albumin infusion during early fluid resuscitation and mortality rate in patients with septic shock, and subgroup analysis was conducted.
Results: The results of multivariate Logistic regression analysis showed that compared with the non-albumin group, the 28-day mortality rate after admission to the ICU decreased after albumin infusion in the early stage of fluid resuscitation (OR = 0.771, 95% CI 0.618-0.961, P = 0.021), while there was no significant difference in the 90-day mortality rate (OR = 0.852, 95% CI 0.690-1.053, P = 0.138) in the albumin group. Subgroup analysis showed that compared with the non-albumin group, the 28-day mortality rate in the albumin group was significantly reduced when serum lactate < 4.6 mmol/L (OR = 0.681, 95% CI 0.487 - 0.952, P = 0.025), plasma urea nitrogen was < 9.1 mmol/L (OR = 0.677, 95% CI 0.461 - 0.996, P = 0.048), or SOFA < 8.5 (OR = 0.596, 95% CI 0.383 - 0.925, P = 0.021).
Conclusion: Compared with not infusing albumin, albumin infusion during early fluid resuscitation in septic shock patients may reduce the 28-day mortality rate after admission to the ICU, with no significant difference at 90-day mortality rate. |
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