INTRODUCTION: Conservative kidney management (CKM) is a recognised treatment option for selected patients with chronic kidney disease stage 5 (CKD G5), but prognostic indicators for mortality and optimal timing for palliative care transition remain uncertain. METHOD: This is a single-centre, prospective cohort study of CKD G5 patients who opted for CKM, conducted between April 2021 and September 2024, with longitudinal monitoring of Edmonton Symptom Assessment System Revised: Renal; Palliative Perfor-mance Scale (PPS); Resources Utilisation Group.Activities of Daily Living (RUG-ADL) scale; Clinical Frailty Score; Karnofsky Performance Score; and clinical and laboratory data. Primary outcomes included identifying baseline mortality predictors and validating the PPS for survival estimation. Cox proportional hazards models were used to identify independent predictors of mortality. RESULTS: Among 109 patients (mean age 79.8±7.3 years, 64.2% female), 62 (56.9%) died during follow-up. Multivariate analysis identified baseline estimated glomerular filtration rate (eGFR) (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.08.1.68, P<0.01) and serum albumin (HR 1.24, 95% CI 1.08.1.43, P<0.01) as predictors of 1-year mortality. Median survival varied by eGFR: 3.0 months (95% CI 0.6.2) for eGFR .5 mL/min/1.73 m², 13.0 months (95% CI 9.1.16.9) for eGFR 6.10 mL/ min/1.73 m², and 20.0 months (95% CI 16.5.23.5) for eGFR >10 mL/min/1.73 m² (P<0.01). Subsequent PPS correlated strongly with survival, with median survival of 1.8 months for PPS <50, 5.3 months for PPS 50.60, and 7.9 months for PPS 70.80 (P=0.03). CONCLUSION Baseline eGFR and serum albumin predict 1-year mortality in CKM patients. PPS offers a practical tool for identifying patients requiring palliative care transition, supporting personalised care pathways and timely integration of palliative care.
Humans ; Female ; Male ; Aged ; Prospective Studies ; Glomerular Filtration Rate ; Palliative Care/methods* ; Conservative Treatment/methods* ; Aged, 80 and over ; Prognosis ; Serum Albumin/analysis* ; Proportional Hazards Models ; Activities of Daily Living ; Singapore/epidemiology*

OBJECTIVES: To study the clinical characteristics and risk factors of pyogenic liver abscess complicated by sepsis in children. METHODS: A retrospective analysis was conducted on the clinical data of 120 children with pyogenic liver abscess admitted from May 2004 to January 2024. According to the presence of sepsis, the children were divided into a sepsis group (82 cases) and a non-sepsis group (38 cases). The clinical characteristics of the two groups were compared, and risk factors associated with the occurrence of sepsis were identified. RESULTS: Among the 120 children with pyogenic liver abscess, 68.3% (82/120) had sepsis. Multivariate logistic regression analysis showed that fever, elevated white blood cell count, and decreased albumin level were closely associated with the occurrence of sepsis (P<0.05). Receiver operating characteristic curve analysis indicated that white blood cell count and albumin levels had significant predictive value for sepsis (P<0.05), and the combination of white blood cell count and albumin level showed higher predictive value for sepsis than the albumin level alone (P<0.05). CONCLUSIONS The clinical manifestations of children with pyogenic liver abscess complicated by sepsis are non-specific. Fever, elevated white blood cell count, and decreased albumin level are risk factors for sepsis in children with pyogenic liver abscess. Clinically, for children with unexplained fever and imaging suggestive of liver abscess, pyogenic liver abscess should be considered. If laboratory tests show elevated white blood cell count and decreased albumin level simultaneously, there should be a high level of suspicion for the development of sepsis.
Humans ; Liver Abscess, Pyogenic/blood* ; Male ; Female ; Risk Factors ; Retrospective Studies ; Sepsis/etiology* ; Child, Preschool ; Infant ; Child ; Leukocyte Count ; Logistic Models ; Adolescent ; Serum Albumin/analysis*

BACKGROUND: Chronic kidney disease (CKD) poses a major global health challenge, often foreshadowing poor patient outcomes. The C-reactive protein to albumin ratio (CAR) serves as a pivotal biomarker, demonstrating a strong correlation with adverse outcomes in cardiovascular disease (CVD). This study sought to examine the correlation between CAR and the risk of all-cause and cardiovascular mortality in patients with CKD stages 3-5. METHODS: This study utilized data of CKD patients from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010, with follow-up to December 31, 2019. The optimal CAR cutoff value was identified utilizing the method of maximally selected rank statistics. Multivariable Cox proportional hazards regression model, restricted cubic splines (RCS) model, and subgroup analysis were employed to assess the association between CAR and mortality among CKD patients. RESULTS: During a median (with interquartile range) follow-up period of 115 (112,117) months among 2,841 CKD individuals, 1,893 deaths were observed, including 692 deaths due to CVD events. Based on the RCS analysis, a non-linear correlation was observed between CAR and mortality. Using 0.3 as the optimal CAR cutoff value, the cohort was divided into high and low groups. In the fully adjusted model, CKD patients with high CAR values exhibited an elevated risk of all-cause mortality (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.28-1.83, P < 0.001) and cardiovascular mortality (HR 1.48, 95% CI 1.08-2.02, P = 0.014). Compared to the population aged >65 years (HR 1.32, 95% CI 0.99-1.76, P = 0.064), the risk of cardiovascular mortality was significantly higher in those aged ≤65 years (HR 2.19, 95% CI 1.18-4.09, P = 0.014) with elevated CAR levels. CONCLUSIONS A notable correlation exists between the elevation of CAR and increased all-cause and cardiovascular mortality, suggesting its potential as an independent indicator for evaluating the prognosis of patients with CKD stages 3-5.
Humans ; Renal Insufficiency, Chronic/epidemiology* ; Cardiovascular Diseases/blood* ; Male ; Female ; Middle Aged ; C-Reactive Protein/metabolism* ; Aged ; Biomarkers/blood* ; Nutrition Surveys ; Adult ; United States/epidemiology* ; Serum Albumin/analysis*

OBJECTIVES: To investigate the association of serum albumin level after human albumin infusion with 28-day mortality in critically ill patients with acute kidney injury (AKI) and its impact on 90-day outcomes of the patients. METHODS: We conducted a retrospective cohort study based on the MIMIC IV database (2008-2019), including 5918 AKI patients treated with albumin in the ICU. Based on serum albumin levels within 72 h after albumin infusion, the patients were divided into low (<30 g/L), medium (30-35 g/L), and high albumin (>35 g/L) groups. Restricted cubic spline regression and multivariate logistic regression were used to analyze the association of albumin levels with patient mortality, and the results were verified in a external validation cohort consisting of 110 sepsis-induced AKI patients treated in Nanfang Hospital between 2017 and 2022 using survival analysis and multivariate adjustment. RESULTS: In the MIMIC training cohort, multivariate logistic regression showed no significant differences in 28-day mortality of the patients with different albumin levels (P>0.05). However, restricted cubic spline analysis indicated a non-linear dose-response relationship between albumin levels and 28-day mortality (threshold effect: risk increased when albumin levels >3.6 g/dL). Secondary endpoint analysis revealed that the patients with high albumin levels had a shorter duration of mechanical ventilation (P<0.001) but a longer ICU stay (P<0.001). In the validation cohort, albumin levels ≥30 g/L were significantly associated with a reduced 28-day mortality rate (P<0.05). CONCLUSIONS The association between increased serum albumin levels following albumin infusion and 28-day mortality of critically ill patients with AKI exhibits a cohort dependency and can be influenced by multiple factors including disease type and severity, infusion strategies, and statistical methods.
Humans ; Acute Kidney Injury/therapy* ; Critical Illness/mortality* ; Retrospective Studies ; Serum Albumin/analysis* ; Male ; Female ; Intensive Care Units ; Middle Aged ; Logistic Models ; Aged

OBJECTIVE: To investigate the predictive value of early lactate/albumin ratio (LAR) combined with quick sequential organ failure assessment (qSOFA) for the 28-day prognosis of patients with sepsis caused by emergency community-acquired pneumonia (CAP). METHODS: The clinical data of patients with sepsis caused by CAP admitted to the department of emergency of Beijing Haidian Hospital from June 2021 to August 2022 were retrospectively analyzed, including gender, age, comorbidities, lactic acid (Lac), serum albumin (Alb), LAR, procalcitonin (PCT) within 1 hour, and 28-day prognosis. Patients were divided into two groups based on 28-day prognosis, and risk factors affecting patients' prognosis were analyzed using univariate and multivariate Cox regression methods. Patients were divided into two groups according to the best cut-off value of LAR, and Kaplan-Meier survival curves were used to analyze the 28-day cumulative survival of patients in each group. Time-dependent receiver operator characteristic curve (ROC curve) were plotted to analyze the predictive value of sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), and qSOFA+LAR score on the prognosis of patients with sepsis caused by CAP at 28 days. The area under the curve (AUC) was calculated and compared. RESULTS: A total of 116 patients with sepsis caused by CAP were included, of whom 80 survived at 28 days and 36 died, 28-day mortality of 31.0%. There were no statistically significant differences in age, gender, comorbidities, pH, platelet count, and fibrinogen between the survival and death groups, and there were significantly differences in blood urea nitrogen (BUN), white blood cell count (WBC), hemoglobin, Lac, Alb, PCT, D-dimer, LAR, as well as qSOFA score, SOFA score, and APACHE II score. Univariate Cox regression analyses showed that BUN, WBC, pH, Lac, Alb, PCT, LAR, qSOFA score, SOFA score, and APACHE II score were associated with mortality outcome. Multifactorial Cox regression analysis of the above variables showed that BUN, WBC, PCT, and APACHE II score were independent risk factors for 28-day death in the emergency department in patients with sepsis caused by CAP [hazard ratio (HR) were 1.081, 0.892, 1.034, and 1.135, respectively, all P < 0.05]. The best cut-off value of early LAR for predicting the 28-day prognosis of sepsis patients was 0.088, the Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of sepsis patients in the LAR ≤ 0.088 group was significantly higher than that in the LAR > 0.088 group [82.9% (63/76) vs. 42.5% (17/40), Log-Rank test: χ² = 22.51, P < 0.001]. The qSOFA+LAR score was calculated based on the LAR cut-off value and qSOFA score, and ROC curve analysis showed that the AUCs of SOFA score, APACHE II score, and qSOFA+LAR score for predicting 28-day death of patients with sepsis caued by CAP were 0.741, 0.774, and 0.709, respectively, with the AUC of qSOFA+LAR score slightly lower than those of SOFA score and APACHE II score, but there were no significantly differences. When the best cut-off value of qSOFA+LAR score was 1, the sensitivity was 63.9% and the specificity was 80.0%. CONCLUSION The qSOFA+LAR score has predictive value for the 28-day prognosis of patients with sepsis caused by CAP in the emergency department, its predictive value is comparable to the SOFA score and the APACHE II score, and it is more convenient for early use in the emergency department.
Emergency Service, Hospital/statistics & numerical data* ; Sepsis/etiology* ; Prognosis ; Community-Acquired Pneumonia/mortality* ; Organ Dysfunction Scores ; Predictive Value of Tests ; Lactic Acid/blood* ; Serum Albumin, Human/analysis* ; Biomarkers/blood* ; Retrospective Studies ; Hospital Mortality ; Kaplan-Meier Estimate ; APACHE ; Procalcitonin/blood* ; ROC Curve ; Area Under Curve ; Humans

OBJECTIVE: To explore the prognostic value of C-reactive protein (CRP)/albumin (Alb) ratio combined with platelet count (PLT) and Glasgow coma score (GCS) in patients with heat stroke (HS). METHODS: A retrospective analysis was conducted on the clinical data of HS patients admitted to the department of intensive care unit (ICU) of Nanchong Central Hospital from May 1, 2020 to October 31, 2023. This included general information, admission GCS, laboratory indicators and 28-day prognosis. The differences in the above indicators were compared between two groups of patients with different prognoses. Statistically significant indicators from univariate analysis were included in multivariate Logistic regression analysis to screen for factors influencing 28-day mortality in HS patients. The predictive value of various influencing factors on the 28 days prognosis of HS patients were analyzed by receiver operator characteristic curve (ROC curve). RESULTS: A total of 73 HS patients were included, of whom 41 survived for 28-day and 32 died. There were no statistically significant differences in gender and age between the two groups of HS patients with different prognoses. The white blood cell count (WBC), neutrophil count (NEU), aspartate aminotransferase (AST), alanine aminotransferase (ALT), CRP, and CRP/Alb ratio in the death group were significantly higher than those of the survival group, and the admission GCS score, platelet count (PLT), total bilirubin (TBil) and Alb were significantly lower than the survival group [WBC (×10⁹/L): 14.80 (11.44, 17.15) vs. 11.96 (9.47, 14.82), NEU (×10⁹/L): 13.05 (8.56, 15.67) vs. 9.50 (6.68, 12.09), AST (U/L): 108.00 (52.70, 291.50) vs. 64.50 (38.25, 110.50), ALT (U/L): 62.00 (19.50, 159.00) vs. 34.50 (20.75, 70.75), CRP (mg/L): 22.49 (3.42, 58.93) vs. 3.68 (1.01, 11.46), CRP/Alb ratio: 0.53 (0.08, 1.77) vs. 0.08 (0.02, 0.44), GCS score: 7.0 (5.0, 8.0) vs. 8.5 (7.0, 11.0), PLT (×10⁹/L): 107.00 (73.50, 126.00) vs. 131.50 (107.50, 176.25), TBil (mmol/L): 15.60 (10.00, 25.30) vs. 21.40 (14.80, 30.05), Alb (g/L): 32.65 (32.53, 49.30) vs. 38.70 (36.20, 40.40), all P < 0.05]. Binary Logistic regression analysis showed that the GCS score [odds ratio (OR) = 0.686, 95% confidence interval (95%CI) was 0.491-0.959, P = 0.028], PLT (OR = 0.973, 95%CI was 0.954-0.992, P = 0.005), NEU (OR = 1.312, 95%CI was 1.072-1.606, P = 0.009) and CRP/Alb ratio (OR = 7.652, 95%CI was 1.632-35.881, P = 0.010) were independent influencing factors for 28-day mortality in HS patients. ROC curve analysis showed that the area under the curve (AUC) of GCS score, PLT, and CRP/Alb ratio for single prediction of 28-day prognosis in HS patients was 0.705, 0.752, and 0.729, and the combination of all three predicted the highest AUC of 28-day prognosis in HS patients (0.917), with a sensitivity and specificity of 86.2% and 81.2%, respectively. CONCLUSION CRP/Alb ratio, PLT, and GCS score are independent influencing factors affecting the prognosis of HS patients, and all of them have a certain predictive value for the prognosis of HS patients, in which the combination of the three has a higher predictive value for the prognosis of HS patients.
Humans ; C-Reactive Protein/analysis* ; Prognosis ; Glasgow Coma Scale ; Retrospective Studies ; Heat Stroke/diagnosis* ; Platelet Count ; Male ; Female ; Serum Albumin/analysis* ; Middle Aged ; Aged ; Adult ; ROC Curve

OBJECTIVE: To explore the predictive efficacy of the early lactic acid/albumin ratio (LAR) for the occurrence of acute skin failure (ASF) in patients with sepsis. METHODS: A retrospective study was conducted to collect the clinical data of 115 patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Dalian Medical University from June 2022 to March 2024. The patients' gender, age, length of ICU stay, past medical history, and severity scores, use of mechanical ventilation or vasoactive drugs, albumin (Alb), lactic acid (Lac), mean arterial pressure (MAP), and blood gas analysis indicators within 24 hours of ICU admission were collected, and LAR was calculated. The patients were divided into two groups based on whether they developed ASF, and the clinical data between the two groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors for the occurrence of ASF in patients with sepsis. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of LAR for the occurrence of ASF in patients with sepsis. RESULTS: A total of 115 patients with sepsis were enrolled in the final analysis, among whom 35 developed ASF and 80 did not. The incidence of ASF was 30.43%. Univariate analysis showed that compared with the non-ASF group, the ASF group had higher acute physiology and chronic health evaluation II (APACHE II) score, proportion of using vasoactive drugs, Lac, and LAR as well as lower Alb and MAP, with statistically significant differences. Multivariate Logistic regression analysis was conducted on the factors with statistical significance in the univariate analysis, and the results showed that Alb [odds ratio (OR) = 0.639, 95% confidence interval (95%CI) was 0.474-0.862, P = 0.003], Lac (OR = 17.228, 95%CI was 1.517-195.641, P = 0.022), MAP (OR = 0.905, 95%CI was 0.855-0.959, P = 0.001), and LAR (OR < 0.001, 95%CI was < 0.001-0.005, P = 0.033) were independent risk factors for the occurrence of ASF in patients with sepsis. ROC curve analysis showed that the area under the ROC curve (AUC) of LAR for predicting the occurrence of ASF in patients with sepsis was 0.867 (95%CI was 0.792-0.943), which was superior to Alb, Lac, and MAP [AUC (95%CI) was 0.739 (0.648-0.829), 0.844 (0.760-0.929), and 0.860 (0.783-0.937), respectively]. When the optimal cut-off value of LAR was 0.11, the sensitivity was 65.7%, the specificity was 96.3%, and the Youden index was 0.620. Patients were grouped based on the optimal cut-off value of LAR, and the results showed that the incidence of ASF in the LAR > 0.11 group was significantly higher than that in the LAR ≤ 0.11 group [88.89% (24/27) vs. 12.50% (11/88), P < 0.05]. CONCLUSIONS LAR has early predictive value for the occurrence of ASF in patients with sepsis, and its efficacy is superior to that of Lac or Alb alone.
Humans ; Sepsis/blood* ; Retrospective Studies ; Lactic Acid/blood* ; Male ; Female ; Intensive Care Units ; Middle Aged ; Risk Factors ; Predictive Value of Tests ; Serum Albumin/analysis* ; ROC Curve ; Aged

OBJECTIVE: To investigate the value of difference between hematocrit (HCT) and albumin (Alb) in predicting the prognosis of patients with sepsis. METHODS: A retrospective study was conducted on the septic patients hospitalized at the First Affiliated Hospital of Guangxi Medical University from January to October in 2024. Clinical data including gender, age, body mass index (BMI), history of hypertension or diabetes, vital signs on admission, and sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, blood lactic acid (Lac), oxygenation index (PaO₂/FiO₂), hemoglobin (Hb), white blood cell count (WBC), platelet count (PLT), lymphocyte count (LYM), HCT, Alb, difference between HCT and Alb, bilirubin, scrum creatinine (SCr), and fibrinogen (Fib) within 48 hours of admission were collected. The 28-day prognosis of patients was also recorded. Binary multivariate Logistic regression analysis was used to identify risk factors for 28-day death in patients with sepsis. The predictive efficacy of the difference between HCT and Alb on 28-day death was evaluated using the receiver operator characteristic curve (ROC curve). RESULTS: Among 180 enrolled septic patients, 140 survived and 40 died on 28 days. Compared with the survival group, the patients in the death group was significantly older (years old: 64±16 vs. 55±15, P < 0.05), and had higher SOFA score, APACHE II score, and SCr [SOFA score: 6 (4, 9) vs. 3 (2, 5), APACHE II score: 13 (10, 18) vs. 8 (6, 11), SCr (μmol/L): 136 (70, 416) vs. 77 (58, 126), all P < 0.05] as well as lower Hb, PLT, HCT, difference between HCT and Alb, and Fib within 48 hours of admission [Hb (g/L): 90±30 vs. 106±79, PLT (×10⁹/L): 158 (57, 240) vs. 215 (110, 315), HCT: 0.258±0.081 vs. 0.333±0.077, difference between HCT and Alb: -6.52±7.40 vs. 1.07±7.63, Fib (g/L): 3.72±1.57 vs. 4.59±1.55, all P < 0.05]. No significant difference in gender, BMI, history of hypertension or diabetes, vital signs on admission, or other laboratory indicators was found between the two groups. Binary multivariate Logistic regression analysis revealed that age [odds ratio (OR) = 1.040, 95% confidence interval (95%CI) was 1.004-1.078, P = 0.030], APACHE II score (OR = 1.218, 95%CI was 1.038-1.430, P = 0.016), Hb (OR = 1.040, 95%CI was 1.014-1.068, P = 0.003), and difference between HCT and Alb (OR = 0.804, 95%CI was 0.727-0.889, P < 0.001) were independent risk factors for 28-day death of septic patients. ROC curve analysis showed that the area under the ROC curve (AUC) of difference between HCT and Alb for predicting 28-day death of septic patients was 0.764 (95%CI was 0.679-0.849, P < 0.001). A cut-off value of difference between HCT and Alb ≤ -5.35 yielded a sensitivity of 80.7% and specificity of 65.0%. CONCLUSIONS The difference between HCT and Alb at early admission is a valuable predictor of prognosis in septic patients. A difference ≤ -5.35 indicates an increased death risk of septic patients.
Humans ; Prognosis ; Sepsis/blood* ; Retrospective Studies ; Hematocrit ; Serum Albumin/analysis* ; Male ; Female ; Middle Aged ; Aged ; APACHE

OBJECTIVE: To stratify systemic lupus erythematosus (SLE) patients clinically, to analyze the clinical characteristics of patients with and without disease activity, and to explore the application va-lue of key clinical indicators in assessing disease activity, as well as to construct an evaluation model. METHODS: A retrospective analysis was conducted on clinical data of the SLE patients diagnosed at Peking University People' s Hospital from May 1995 to April 2014. Demographic information, clinical manifestations, laboratory tests, and antibody detection results were collected. The patients were divided into active and inactive groups based on systemic lupus erythematosus disease activity index 2000(SLEDAI-2000)scores. t-tests, Mann-Whitney U tests, and χ² tests were used to compare the differences between the groups. Spearman correlation analysis was used to evaluate the relevant clinical indicators associated with SLE activity in the active disease group. Based on the results of statistical analysis, a Logistic regression model was constructed, and the performance of the model was evaluated. RESULTS: No significant differences were found in demographic characteristics between the two groups. In the active disease group, positive rates of antinuclear antibodies (ANA) and anti-double-stranded DNA antibodies (anti-dsDNA) were increased; white blood cell count (WBC), red blood cell count (RBC), hemoglobin (HGB), lymphocytes (LY), total protein (TP), albumin (ALB), and complement 3(C3) levels were significantly decreased; while immunoglobulin A and G levels were markedly elevated. The correlation analysis results showed that hemoglobin, albumin, C3, and complement 4(C4) had higher correlation indices compared with other clinical indicators. Among these, C3 exhibited a certain negative correlation with disease activity. The Logistic regression model based on 12 significantly different indicators (P < 0.05) achieved an accuracy of 91.4%, sensitivity of 94.4%, specificity of 81.0%, and the area under curve (AUC) of the receiver operating characteristic (ROC) was 0.944. CONCLUSION This study comprehensively evaluated a range of clinical indicators related to SLE disease activity, providing a thorough understanding of both laboratory and clinical markers. The Logistic regression model, which was primarily constructed using laboratory test indicators, such as inflammatory markers, immune response parameters, and organ involvement metrics, demonstrated a high degree of accuracy in assessing the disease activity in SLE patients. Consequently, this model might provide a new basis for the diagnosis and treatment of SLE patients, offering significant clinical diagnostic value.
Humans ; Lupus Erythematosus, Systemic/diagnosis* ; Retrospective Studies ; Antibodies, Antinuclear/blood* ; Complement C3/metabolism* ; Complement C4/metabolism* ; Logistic Models ; Severity of Illness Index ; Leukocyte Count ; Female ; Male ; Serum Albumin/analysis*

OBJECTIVE: To evaluate the predictive value of plasma heparin-binding protein (HBP) combined with albumin (Alb) for predicting 28-day mortality in patients with sepsis. METHODS: The clinical data of patients with sepsis admitted to the emergency intensive care unit (EICU) of the People's Hospital of Shenzhen Baoan District from March 2020 to March 2024 were retrospectively analyzed. The study began at the time of the first diagnosis of sepsis upon EICU admission and ended upon patient death or at 28 days. The gender, age, length of stay in EICU, underlying diseases, and infection sites were recorded. Within 24 hours of sepsis diagnosis, blood culture results, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), blood lactate acid (Lac), HBP, Alb, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), mortality in emergency department sepsis score (MEDS), modified early warning score (MEWS), number of organ failures, use of vasopressors, application of mechanical ventilation, renal replacement therapy, and 28-day prognosis were recorded, the differences in these indicators between two groups were compared. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors of 28-day mortality in patients with sepsis. Receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the early predictive value of various risk factors for 28-day mortality in patients with sepsis. RESULTS: A total of 300 patients with sepsis were included, with 16 excluded, resulting in 284 patients being analyzed. Among them, 191 survived and 93 died within 28 days. There were no statistically significant differences between the two groups in terms of gender, age, underlying diseases, infection sites, blood culture positivity rate, number of organ failures, and length of stay in EICU. Univariate analysis showed that the rate of vasopressor use, the rate of mechanical ventilation, HBP, PCT, CRP, Lac, SOFA score, APACHE II score, MEDS score, and MEWS score were significantly higher in the death group than those in the survival group, while Alb was significantly lower in the death group than that in the survival group. Multivariate Logistic regression analysis showed that HBP and Alb were independent risk factors for predicting 28-day mortality in patients with sepsis [odds ratio (OR) and 95% confidence interval (95%CI) were 1.093 (0.989-1.128) and 1.174 (1.095-1.259), both P < 0.05]. ROC curve analysis showed that both HBP and Alb had certain predictive value for 28-day mortality in patients with sepsis [AUC and 95%CI were 0.820 (0.717-0.923) and 0.786 (0.682-0.890), both P < 0.05]. When the critical value of HBP was 117.50 μg/L, the sensitivity was 85.90%, and the specificity was 70.50%. When the critical value of Alb was 28.30 g/L, the sensitivity was 69.30%, and the specificity was 81.20%. When the two indexes were combined for diagnosis, the AUC was 0.881 (95%CI was 0.817-0.945, P < 0.001), the sensitivity was 92.70%, and the specificity was 76.80%. CONCLUSIONS HBP and Alb are independent risk factors for predicting 28-day mortality in patients with sepsis. The combined prediction efficiency of HBP and Alb for 28-day mortality in patients with sepsis is superior to a single indicator.
Humans ; Sepsis/diagnosis* ; Retrospective Studies ; Predictive Value of Tests ; Intensive Care Units ; Blood Proteins/analysis* ; Prognosis ; Antimicrobial Cationic Peptides/blood* ; APACHE ; Male ; Female ; Organ Dysfunction Scores ; ROC Curve ; Middle Aged ; C-Reactive Protein/analysis* ; Emergency Service, Hospital ; Aged ; Hospital Mortality ; Serum Albumin/analysis*