C反应蛋白/白蛋白对脓毒症患者出现Ⅲ级以上AGI的预测价值
Predictive Value of C-Reactive Protein/Albumin for the Development of Grade III or Higher AGI in Patients with Sepsis

目的：探讨C反应蛋白与白蛋白比值(CAR)对脓毒症患者出现III级及以上急性胃肠损伤(acute gastrointestinal injury, AGI)的预测价值。方法：采用回顾性队列研究，选取2020年1月至2023年3月合肥市第二人民医院重症医学科收治的166例脓毒症患者的临床资料，根据住院期间是否发生III级以上AGI症状将研究对象分为AGI组(80例)及N-AGI组(86例)，比较两组患者入院首日的白细胞、C反应蛋白(CRP)、白蛋白(ALB)、C反应蛋白与白蛋白比值(CAR)、降钙素原(PCT)、乳酸、急性生理与慢性健康II评分(APACHE II)、序贯器官衰竭评分(SOFA)等一系列指标，采用logistic回归分析脓毒症III级以上AGI的独立危险因素，采用受试者工作特征(receiver operating characteristic, ROC)曲线分析CAR对脓毒症患者出现III级以上AGI的预测价值。结果：AGI组的SOFA评分、PCT、CRP、CAR水平均高于N-AGI组，ALB低于N-AGI组，差异具有统计学意义(P < 0.05)；多因素Logistic回归分析提示，CAR (β = 0.546, OR = 1.726, 95% CI: 1.041~2.863, P < 0.05)是脓毒症患者III级以上AGI的独立危险因素(P < 0.05)；ROC曲线提示，SOFA评分、PCT、CRP、ALB、CAR预测脓毒症患者发生胃肠损伤的曲线下面积(area under the curve, AUC)分别为0.605、0.769、0.938、0.315、0.944，提示CAR的预测价值明显高于其他，95%置信区间为0.912~0.976。结论：C反应蛋白/白蛋白比值(CAR)对脓毒症患者出现III级以上急性胃肠损伤具有较好的预测价值，有助于临床医生早期识别高危患者。
Objective: To determine if the C-reactive protein to albumin ratio (CAR) can accurately predict acute gastrointestinal injury (AGI) of grade III or higher in sepsis patients. Methods: In order to collect the clinical data of 166 sepsis patients admitted to the Department of Critical Care Medicine of the Second People’s Hospital of Hefei City between January 2020 and March 2023, a retrospective cohort study was carried out. AGI group (80 cases) and the N-AGI group (86 cases) were created from the study participants based on whether or not they experienced grade III or higher AGI symptoms while hospitalized. Leukocytes, C-reactive protein (CRP), albumin (ALB), C-reactive protein to albumin ratio (CAR), procalcitonin (PCT), lactic acid, acute physiology and chronic health II scores (APACHE II), and sequential organ failure scores (SOFA) were among the many indexes that we compared between the two groups on the first day of admission. We also used logistic regression to analyze the independent risk factors of sepsis grade III or above AGI as well as the work characteristics (receiver) of the subjects. The predictive value of CAR for the emergence of grade III or higher AGI in sepsis patients use the characteristic curve of retention (ROC). Results: The results of multifactorial logistic regression analysis indicated that CAR (β = 0.546, OR = 1.726, 95% confidence intervals: 1.041~2.863, P < 0.05) was an independent risk factor for grade III or higher AGI in sepsis patients; the areas under the curve (AUC) of SOFA score, PCT, CRP, ALB, and CAR for predicting the occurrence of gastrointestinal injury in sepsis patients were 0.605, 0.769, 0.938, 0.315, and 0.944, indicating that the predictive value of CAR is significantly higher