根据MIMIC-IV数据,血清乳酸与危急性缺血性中风患者的死亡率之间的关联
Zongren Zhao1, Yu Liu1, Huanhuan Ji2
1Department of Neurosurgery, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, 223002, China.
Scientific reports
|July 18, 2025
概括
动态血清乳酸水平预测缺血性中风患者的死亡率. 较慢的乳酸下降表明死亡风险更高,特别是在男性,老年人和糖尿病患者中.
科学领域:
- 神经学 神经学
- 生物化学 生物化学
- 临界护理医学 临界护理医学
背景情况:
- 缺血性中风是导致残疾和死亡的主要原因.
- 血清乳酸是众所周知的各种严重疾病的预后标志物.
- 在缺血性中风中,动态乳酸轨迹的预后价值尚不清楚.
研究的目的:
- 研究血清乳酸度轨迹与缺血性中风患者全因死亡率之间的关联.
- 识别不同的乳酸水平模式及其与患者结果的相关性.
主要方法:
- 利用来自MIMIC-IV数据库的752名缺血性中风患者的数据,在ICU入院7天内至少进行两次乳酸测量.
- 采用基于组的轨迹建模 (GBTM) 来识别乳酸轨迹.
- 使用卡普兰-梅尔曲线和考克斯回归模型进行生存分析.
主要成果:
- 确定了两个乳酸的轨迹:一个更的减少 (第1类) 和一个更渐进的减少 (第2类).
- 第二类患者的临床严重性得分更高 (SOFA,APS III,SAPS II,OASIS),死亡率也更高.
- 卡普兰-梅尔分析和考克斯回归显示,与1级相比,2级的生存率明显较差 (HRs1.41-3.37,p<0.05).
- 亚组分析表明男性,老年人,糖尿病患者和BMI较高的人的风险增加.
结论:
- 血清乳酸度轨迹是缺血性中风的显著预后指标.
- 乳酸水平的逐渐,持续下降与死亡风险的增加有关.
- 确定特定的患者亚组 (男性,老年人,糖尿病患者,超重/肥胖患者) 可以帮助风险分层和有针对性的干预措施.
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