重症监护病房急性胰腺炎患者入科首日血清白蛋白与院内死亡风险的相关性研究
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南京医科大学第一附属医院胰腺中心

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A study on the correlation between first-day serum albumin on ICU admission and in-hospital mortality risk in patients with acute pancreatitis
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    摘要:

    目的: 急性胰腺炎(acute pancreatitis, AP)是常见的消化系统急症,重症患者死亡率高,早期风险识别至关重要。本研究旨在探讨重症监护病房(intensive care unit, ICU)AP患者入科首日血清白蛋白(Albumin, ALB)水平与院内死亡风险的关联及其潜在的非线性关系。 方法: 本研究回顾性分析了MIMIC-IV数据库中2008年至2019年首次入住ICU的728例成年AP患者数据。提取患者入ICU首日ALB水平及相关临床资料,采用多因素Logistic回归模型评估ALB与院内死亡风险的线性关系,并通过广义加性模型(Generalized Additive Model, GAM)和两分段线性回归模型探索非线性关系及拐点。 结果: 在调整多个混杂因素后,入ICU首日ALB水平每升高1 g/L,患者院内死亡风险降低27%(OR 0.73, 95% CI 0.59–0.92, P=0.007)。GAM分析进一步揭示ALB与院内死亡风险之间存在显著的非线性关系,拐点为28 g/L。当ALB ≤ 28 g/L时,ALB每升高1 g/L,院内死亡风险显著降低56%(OR 0.44, 95% CI 0.26–0.73, P=0.001);而当ALB > 28 g/L时,此关联无统计学意义。 结论: ICU AP患者入科首日血清ALB水平与院内死亡风险呈显著的非线性负相关,28 g/L是识别高风险患者的一个重要临床拐点。早期监测并关注ALB水平对AP患者的风险分层和临床决策具有重要意义。

    Abstract:

    Objective: Acute pancreatitis (AP) is a common digestive emergency with high mortality in severe cases, making early risk identification crucial. This study aimed to investigate the association between first-day serum albumin (ALB) levels upon intensive care unit (ICU) admission and in-hospital mortality in patients with AP, and to explore its potential non-linear nature. Methods: This retrospective study analyzed data from 728 adult AP patients admitted to the ICU for the first time between 2008 and 2019, sourced from the MIMIC-IV database. First-day ICU ALB levels and relevant clinical data were extracted. Multivariable logistic regression models were used to assess the linear association between ALB and in-hospital mortality. Generalized additive models (GAM) and two-piecewise linear regression models were employed to explore non-linear relationships and identify inflection points. Results: After adjusting for multiple confounders, each 1 g/L increase in first-day ICU ALB was associated with a 27% reduction in in-hospital mortality risk (OR 0.73, 95% CI 0.59–0.92, P=0.007). GAM analysis further revealed a significant non-linear relationship between ALB and in-hospital mortality, with an inflection point at 28 g/L. When ALB was ≤ 28 g/L, each 1 g/L increase was associated with a 56% significant reduction in mortality risk (OR 0.44, 95% CI 0.26–0.73, P=0.001); however, this association was not statistically significant when ALB was > 28 g/L. Conclusion: First-day ICU serum albumin levels in patients with AP demonstrated a significant non-linear negative association with in-hospital mortality. An ALB level of 28 g/L was identified as an important clinical inflection point for distinguishing high-risk patients. Early monitoring and attention to ALB levels are crucial for risk stratification and clinical decision-making in AP patients.

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  • 收稿日期:2025-05-21
  • 最后修改日期:2025-07-01
  • 录用日期:2025-08-28
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