Zhonghua wei zhong bing ji jiu yi xue · 2026
[Role of secrum albumin-to-creatinine ratio in assessing the prognosis of sepsis].
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Bao Zhiyuan, Li Peng, Zhang Lin
Аннотация
OBJECTIVE: To investigate the role of serum albumin-to-creatinine ratio (sACR) in prognostic assessment of patients with sepsis.
METHODS: A retrospective cohort study was conducted. Patients with newly diagnosed sepsis admitted to the emergency intensive care unit (ICU) and comprehensive ICU of the Fourth Affiliated Hospital of Anhui Medical University from October 2023 to October 2024 were enrolled. Baseline data and laboratory parameters within 24 hours of admission, including white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), serum albumin, and creatinine, were collected, and sACR was calculated. The Acute Physiology and Chronic Health Evaluation II(APACHE II) and Sequential Organ Failure Assessment (SOFA) were recorded at admission. The 28-day survival status and survival time were documented. Patients were divided into sepsis group and septic shock group according to sepsis severity, and further divided into survivor group and non-survivor group based on 28-day outcomes. The above parameters were compared between groups. Cox proportional hazards regression analysis was used to identify independent prognostic factors for 28-day mortality. Receiver operator characteristic curves (ROC curves) were plotted to evaluate the predictive value of each indicator, and the areas under the curves (AUCs) were compared using DeLong's test.
RESULTS: A total of 177 patients with newly diagnosed sepsis were included, comprising 66 in the sepsis group and 111 in the septic shock group; 94 survived and 83 died within 28 days. Significant differences were observed between the sepsis and septic shock groups in age, WBC, CRP, PCT, APACHE II score, SOFA score, and sACR (all P<0.05), with sACR being higher in the sepsis group [2.98 (1.82, 4.10) vs. 2.26 (1.19, 3.08)]. Significant differences were also found between survivors and non-survivors in WBC, CRP, PCT, APACHE II score, SOFA score, and sACR (all P<0.05), with sACR being higher in survivors [3.17 (1.87, 4.20) vs. 1.80 (0.95, 2.25)]. Cox regression analysis showed that CRP (HR=1.004, 95%CI was 1.001-1.007, P=0.043), APACHE II score (HR=1.078, 95%CI was 1.049-1.108, P<0.001), and SOFA score (HR=1.105, 95%CI was 1.027-1.189, P=0.008) were independent risk factors for 28-day all-cause mortality, while sACR was an independent protective factor (HR=0.795, 95%CI was 0.646-0.978, P=0.030). ROC curve analysis revealed that CRP, APACHE II score, SOFA score, and sACR had certain predictive value for 28-day prognosis; the AUC of sACR was 0.765, with an optimal cut-off value of 2.446, yielding a sensitivity of 66.0% and specificity of 77.1%. DeLong's test indicated that the predictive performance of sACR was similar to that of SOFA score, superior to CRP, but inferior to APACHE II score.
CONCLUSIONS: As a novel composite biomarker, sACR has potential adjunctive value in assessing disease severity and predicting prognosis in patients with sepsis.
METHODS: A retrospective cohort study was conducted. Patients with newly diagnosed sepsis admitted to the emergency intensive care unit (ICU) and comprehensive ICU of the Fourth Affiliated Hospital of Anhui Medical University from October 2023 to October 2024 were enrolled. Baseline data and laboratory parameters within 24 hours of admission, including white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), serum albumin, and creatinine, were collected, and sACR was calculated. The Acute Physiology and Chronic Health Evaluation II(APACHE II) and Sequential Organ Failure Assessment (SOFA) were recorded at admission. The 28-day survival status and survival time were documented. Patients were divided into sepsis group and septic shock group according to sepsis severity, and further divided into survivor group and non-survivor group based on 28-day outcomes. The above parameters were compared between groups. Cox proportional hazards regression analysis was used to identify independent prognostic factors for 28-day mortality. Receiver operator characteristic curves (ROC curves) were plotted to evaluate the predictive value of each indicator, and the areas under the curves (AUCs) were compared using DeLong's test.
RESULTS: A total of 177 patients with newly diagnosed sepsis were included, comprising 66 in the sepsis group and 111 in the septic shock group; 94 survived and 83 died within 28 days. Significant differences were observed between the sepsis and septic shock groups in age, WBC, CRP, PCT, APACHE II score, SOFA score, and sACR (all P<0.05), with sACR being higher in the sepsis group [2.98 (1.82, 4.10) vs. 2.26 (1.19, 3.08)]. Significant differences were also found between survivors and non-survivors in WBC, CRP, PCT, APACHE II score, SOFA score, and sACR (all P<0.05), with sACR being higher in survivors [3.17 (1.87, 4.20) vs. 1.80 (0.95, 2.25)]. Cox regression analysis showed that CRP (HR=1.004, 95%CI was 1.001-1.007, P=0.043), APACHE II score (HR=1.078, 95%CI was 1.049-1.108, P<0.001), and SOFA score (HR=1.105, 95%CI was 1.027-1.189, P=0.008) were independent risk factors for 28-day all-cause mortality, while sACR was an independent protective factor (HR=0.795, 95%CI was 0.646-0.978, P=0.030). ROC curve analysis revealed that CRP, APACHE II score, SOFA score, and sACR had certain predictive value for 28-day prognosis; the AUC of sACR was 0.765, with an optimal cut-off value of 2.446, yielding a sensitivity of 66.0% and specificity of 77.1%. DeLong's test indicated that the predictive performance of sACR was similar to that of SOFA score, superior to CRP, but inferior to APACHE II score.
CONCLUSIONS: As a novel composite biomarker, sACR has potential adjunctive value in assessing disease severity and predicting prognosis in patients with sepsis.