术前血清尿酸水平对心脏机械瓣膜置换术后机械通气时间延长的预测价值
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摘要
目的探讨心脏机械瓣膜置换患者术前血清尿酸(UA)水平与术后机械通气时间延长(PMV)之间的关系及其预测价值。方法回顾性分析2017年1～12月间在安徽医科大学第一附属医院心脏大血管外科行心脏机械瓣膜置换手术311例患者的临床资料,其中男164例,平均年龄(55.6±11.4)岁;女147例,平均年龄(54.2±9.8)岁。根据患者术后机械通气时间是否>48 h,分为PMV组(>48 h)和对照组。采用Spearman等级相关系数和logistic回归分析研究术前血清UA水平与术后PMV之间的关系。UA对PMV的预测效能评价使用受试者工作特征(ROC)曲线完成。结果 38例(12.2%)发生术后PMV。全部患者术前血清UA平均浓度为(6.11±1.94)mg/dl,PMV组UA平均浓度显著高于对照组[(7.48±2.24)mg/dl vs.(5.92±1.82)mg/dl,P<0.001]。秩相关分析显示血清中UA的浓度与术后PMV的发生呈正相关(rs=0.205,P<0.001)。多因素logistic回归分析显示术前血清UA水平升高与心脏机械瓣置换术后PMV的发生独立相关[优势比(OR)=1.44,95%可信区间(CI)1.15～1.81,P=0.002]。ROC曲线分析显示术前UA对预测术后PMV的曲线下面积为0.721,95%CI 0.635～0.806,6.40 mg/dl为最佳截断值,此时敏感性为76.3%,特异性为63.0%。结论术前血清UA水平升高是心脏机械瓣膜置换术后PMV的独立危险因素且具有较好的预测价值。
Objective To investigate the association of preoperative serum uric acid(UA) levels with postoperative prolonged mechanical ventilation(PMV) in patients undergoing mechanical heart valve replacement.Methods Clinical data of 311 patients undergoing mechanical heart valve replacement in The First Affiliated Hospital of Anhui Medical University from January 2017 to December 2017 were retrospectively analyzed. There were 164 males at age of 55.6±11.4 years and 147 females at age of 54.2±9.8 years. The patients were divided into a PMV group(>48 h) and a control group according to whether the duration of PMV was longer than 48 hours. Spearman's rank correlation coefficient and logistic regression analysis were conducted to evaluate the relationship between preoperative UA and postoperative PMV. The predictive value of UA for PMV was undertaken using the receiver operating characteristic(ROC) curve.. Results Among 311 patients, 38(12.2%) developed postoperative PMV. Preoperative serum UA level mean values were 6.11±1.94 mg/dl, while the mean UA concentration in the PMV group was significantly higher than that in the control group(7.48±2.24 mg/dl vs. 5.92±1.82 mg/dl, P<0.001). Rank correlation analysis showed that UA was positively correlated with postoperative PMV(rs=0.205, P<0.001). Multivariate logistic regression analysis demonstrated that preoperative elevated UA was associated independently with postoperative PMV with odds ratio(OR)=1.44 and confidence interval(CI) 1.15–1.81(P=0.002). The area under the ROC curve of UA predicting PMV was 0.72, 95%CI0.635–0.806, 6.40 mg/dl was the optimal cut-off value, and the sensitivity and specificity was 76.3% and 63.0% at this time, respectively. Conclusion Preoperative elevated serum UA is an independent risk factor for postoperative PMV in patients undergoing mechanical heart valve replacement and has a good predictive value.
Objective To investigate the association of preoperative serum uric acid(UA) levels with postoperative prolonged mechanical ventilation(PMV) in patients undergoing mechanical heart valve replacement.Methods Clinical data of 311 patients undergoing mechanical heart valve replacement in The First Affiliated Hospital of Anhui Medical University from January 2017 to December 2017 were retrospectively analyzed. There were 164 males at age of 55.6±11.4 years and 147 females at age of 54.2±9.8 years. The patients were divided into a PMV group(>48 h) and a control group according to whether the duration of PMV was longer than 48 hours. Spearman's rank correlation coefficient and logistic regression analysis were conducted to evaluate the relationship between preoperative UA and postoperative PMV. The predictive value of UA for PMV was undertaken using the receiver operating characteristic(ROC) curve.. Results Among 311 patients, 38(12.2%) developed postoperative PMV. Preoperative serum UA level mean values were 6.11±1.94 mg/dl, while the mean UA concentration in the PMV group was significantly higher than that in the control group(7.48±2.24 mg/dl vs. 5.92±1.82 mg/dl, P<0.001). Rank correlation analysis showed that UA was positively correlated with postoperative PMV(rs=0.205, P<0.001). Multivariate logistic regression analysis demonstrated that preoperative elevated UA was associated independently with postoperative PMV with odds ratio(OR)=1.44 and confidence interval(CI) 1.15–1.81(P=0.002). The area under the ROC curve of UA predicting PMV was 0.72, 95%CI0.635–0.806, 6.40 mg/dl was the optimal cut-off value, and the sensitivity and specificity was 76.3% and 63.0% at this time, respectively. Conclusion Preoperative elevated serum UA is an independent risk factor for postoperative PMV in patients undergoing mechanical heart valve replacement and has a good predictive value.
引文
1Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery. Respir Care, 2018, 63(5):550-557.
2He S, Chen B, Li W, et al. Ventilator-associated pneumonia after cardiac surgery:a meta-analysis and systematic review. J Thorac Cardiovasc Surg, 2014, 148(6):3148-3155.e3141-3145.
3Vora CS, Karnik ND, Gupta V, et al. Clinical profile of patients requiring prolonged mechanical ventilation and their outcome in a tertiary care medical ICU. J Assoc Physicians India, 2015, 63(10):14-19.
4Loss SH, de Oliveira RP, Maccari JG, et al. The reality of patients requiring prolonged mechanical ventilation:a multicenter study.Rev Bras Ter Intensiva, 2015, 27(1):26-35.
5Lazzeroni D, Bini M, Camaiora U, et al. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery. Eur J Prev Cardiol, 2018, 25(2):119-126.
6Holme I, Aastveit AH, Hammar N, et al. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in417 ,734 men and women in the Apolipoprotein MOrtality RISk study(AMORIS). J Intern Med, 2009, 266(6):558-570.
7Anker SD, Doehner W, Rauchhaus M, et al. Uric acid and survival in chronic heart failure:validation and application in metabolic,functional, and hemodynamic staging. Circulation, 2003, 107(15):1991-1997.
8Lapsia V, Johnson RJ, Dass B, et al. Elevated uric acid increases the risk for acute kidney injury. Am J Med, 2012, 125(3):302.e309-317.
9Joung KW, Jo JY, Kim WJ, et al. Association of preoperative uric acid and acute kidney injury following cardiovascular surgery. J Cardiothorac Vasc Anesth, 2014, 28(6):1440-1447.
10Lee EH, Choi JH, Joung KW, et al. Relationship between serum uric acid concentration and acute kidney injury after coronary artery bypass surgery. J Korean Med Sci, 2015, 30(10):1509-1516.
11Oura K, Morisawa T, Kamisaka K, et al. Determinants of prolonged mechanical ventilation after cardiac surgery. Kyobu Geka, 2014, 67(7):528-532.
12Bartz RR, Ferreira RG, Schroder JN, et al. Prolonged pulmonary support after cardiac surgery:incidence, risk factors and outcomes:a retrospective cohort study. J Crit Care, 2015, 30(5):940-944.
13Sharma V, Rao V, Manlhiot C, et al. A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2017, 153(1):108-115.
14LoCicero J, 3rd, McCann B, Massad M, et al. Prolonged ventilatory support after open-heart surgery. Crit Care Med, 1992, 20(7):990-992.
15Kataoka H, Yang K, Rock KL. The xanthine oxidase inhibitor Febuxostat reduces tissue uric acid content and inhibits injuryinduced inflammation in the liver and lung. Eur J Pharmacol, 2015,746:174-179.
16Jeha S. Tumor lysis syndrome. Semin Hematol, 2001, 38(4 Suppl10):4-8.
17Martinon F, Petrilli V, Mayor A, et al. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature, 2006,440(7081):237-241.
18Amaral FA, Costa VV, Tavares LD, et al. NLRP3 inflammasomemediated neutrophil recruitment and hypernociception depend on leukotriene B(4)in a murine model of gout. Arthritis Rheum, 2012,64(2):474-484.
19Li Y, Li H, Liu S, et al. Pirfenidone ameliorates lipopolysaccharideinduced pulmonary inflammation and fibrosis by blocking NLRP3inflammasome activation. Mol Immunol, 2018, 99:134-144.
20Ruggiero C, Cherubini A, Miller E, 3rd, et al. Usefulness of uric acid to predict changes in C-reactive protein and interleukin-6 in3 -year period in Italians aged 21 to 98 years. Am J Cardiol, 2007,100(1):115-121.
21Aida Y, Shibata Y, Osaka D, et al. The relationship between serum uric acid and spirometric values in participants in a health check:the Takahata study. Int J Med Sci, 2011, 8(6):470-478.
2He S, Chen B, Li W, et al. Ventilator-associated pneumonia after cardiac surgery:a meta-analysis and systematic review. J Thorac Cardiovasc Surg, 2014, 148(6):3148-3155.e3141-3145.
3Vora CS, Karnik ND, Gupta V, et al. Clinical profile of patients requiring prolonged mechanical ventilation and their outcome in a tertiary care medical ICU. J Assoc Physicians India, 2015, 63(10):14-19.
4Loss SH, de Oliveira RP, Maccari JG, et al. The reality of patients requiring prolonged mechanical ventilation:a multicenter study.Rev Bras Ter Intensiva, 2015, 27(1):26-35.
5Lazzeroni D, Bini M, Camaiora U, et al. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery. Eur J Prev Cardiol, 2018, 25(2):119-126.
6Holme I, Aastveit AH, Hammar N, et al. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in417 ,734 men and women in the Apolipoprotein MOrtality RISk study(AMORIS). J Intern Med, 2009, 266(6):558-570.
7Anker SD, Doehner W, Rauchhaus M, et al. Uric acid and survival in chronic heart failure:validation and application in metabolic,functional, and hemodynamic staging. Circulation, 2003, 107(15):1991-1997.
8Lapsia V, Johnson RJ, Dass B, et al. Elevated uric acid increases the risk for acute kidney injury. Am J Med, 2012, 125(3):302.e309-317.
9Joung KW, Jo JY, Kim WJ, et al. Association of preoperative uric acid and acute kidney injury following cardiovascular surgery. J Cardiothorac Vasc Anesth, 2014, 28(6):1440-1447.
10Lee EH, Choi JH, Joung KW, et al. Relationship between serum uric acid concentration and acute kidney injury after coronary artery bypass surgery. J Korean Med Sci, 2015, 30(10):1509-1516.
11Oura K, Morisawa T, Kamisaka K, et al. Determinants of prolonged mechanical ventilation after cardiac surgery. Kyobu Geka, 2014, 67(7):528-532.
12Bartz RR, Ferreira RG, Schroder JN, et al. Prolonged pulmonary support after cardiac surgery:incidence, risk factors and outcomes:a retrospective cohort study. J Crit Care, 2015, 30(5):940-944.
13Sharma V, Rao V, Manlhiot C, et al. A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2017, 153(1):108-115.
14LoCicero J, 3rd, McCann B, Massad M, et al. Prolonged ventilatory support after open-heart surgery. Crit Care Med, 1992, 20(7):990-992.
15Kataoka H, Yang K, Rock KL. The xanthine oxidase inhibitor Febuxostat reduces tissue uric acid content and inhibits injuryinduced inflammation in the liver and lung. Eur J Pharmacol, 2015,746:174-179.
16Jeha S. Tumor lysis syndrome. Semin Hematol, 2001, 38(4 Suppl10):4-8.
17Martinon F, Petrilli V, Mayor A, et al. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature, 2006,440(7081):237-241.
18Amaral FA, Costa VV, Tavares LD, et al. NLRP3 inflammasomemediated neutrophil recruitment and hypernociception depend on leukotriene B(4)in a murine model of gout. Arthritis Rheum, 2012,64(2):474-484.
19Li Y, Li H, Liu S, et al. Pirfenidone ameliorates lipopolysaccharideinduced pulmonary inflammation and fibrosis by blocking NLRP3inflammasome activation. Mol Immunol, 2018, 99:134-144.
20Ruggiero C, Cherubini A, Miller E, 3rd, et al. Usefulness of uric acid to predict changes in C-reactive protein and interleukin-6 in3 -year period in Italians aged 21 to 98 years. Am J Cardiol, 2007,100(1):115-121.
21Aida Y, Shibata Y, Osaka D, et al. The relationship between serum uric acid and spirometric values in participants in a health check:the Takahata study. Int J Med Sci, 2011, 8(6):470-478.