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Article(id=1194613947077726657, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194613942065533315, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0345.2024.1215, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1705507200000, receivedDateStr=2024-01-18, revisedDate=null, revisedDateStr=null, acceptedDate=1715356800000, acceptedDateStr=2024-05-11, onlineDate=1762747759836, onlineDateStr=2025-11-10, pubDate=1743091200000, pubDateStr=2025-03-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1762747759836, onlineIssueDateStr=2025-11-10, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1762747759836, creator=13701087609, updateTime=1762747759836, updator=13701087609, issue=Issue{id=1194613942065533315, tenantId=1146029695717560320, journalId=1189873630562394117, year='2025', volume='50', issue='3', pageStart='245', pageEnd='365', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1762747758641, creator=13701087609, updateTime=1762749141462, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1194619742100103439, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194613942065533315, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1194619742100103440, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194613942065533315, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=309, endPage=317, ext={EN=ArticleExt(id=1194613947950141895, articleId=1194613947077726657, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Relationship between C-reactive protein/albumin ratio and severity in patients with severe pneumonia and its predictive value for 28-day mortality risk, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the relationship between C-reactive protein/albumin ratio (CAR) and the disease severity in patients with severe pneumonia, and its predictive value for 28-day mortality risk. Methods A retrospective analysis was conducted on 152 patients with severe pneumonia admitted to Fuyang People's Hospital from January 2020 to January 2022. They were divided into non-critical illness group (n=51), critical illness group (n=63), and extremely critical illness group (n=38) based on the disease severity. The clinical data such as age and gender of patients was collected, and Pearson correlation analysis was used to explore the correlation between CAR and the severity of illness [determined by Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score]. Multivariate logistic regression was employed to identify independent influencing factors of the severity of illness. According to the survival status of patients after 28 days of treatment, they were divided into survival group (n=107) and death group (n=45). CAR was categorized into quintiles (Q1-Q5), and multivariate logistic regression analysis was conducted to explore the correlation between CAR and 28-day mortality risk in severe pneumonia patients. A restricted cubic spline (RCS) model was used to analyze the dose-response relationship between CAR and mortality risk. The predictive value of CAR and related indicators for patient mortality risk was evaluated using the receiver operating characteristic curve (ROC). Results CAR was significantly positively correlated with the severity of the disease (APACHE Ⅱ score) (r=0.716, P<0.05). Neutrophil/lymphocyte ratio (NLR), blood lactate (Lac), and high CAR were independent risk factors for the disease severity in patients with severe pneumonia (P<0.05). After adjusting for confounding factors, the mortality risk increased with the increase of CAR (P<0.05). Subgroup analysis of the screened confounding factors revealed that the correlation between CAR and 28-day mortality risk in severe pneumonia patients remained stable across different APACHE Ⅱ scores, GCS scores, SOFA scores, white blood cell counts (WBC), neutrophils (NEU), red cell volume distribution width (RDW), procalcitonin (PCT), and Lac, with interactions observed between NLR and Lac subgroups (P<0.05). The RCS model indicated that there was no non-linear dose-response relationship between CAR and 28-day mortality risk in patients with severe pneumonia of different genders. ROC curve analysis showed that CAR, Lac, and NLR had good predictive value for 28-day mortality in severe pneumonia patients, with the combined predictive efficacy being significantly higher than that of individual indicators. Conclusion There is a close relationship between CAR and the progression and prognosis of severe pneumonia, making it a new approach to assessing the severity of illness and predicting mortality risk in patients.

, correspAuthors=Dong-Feng Li, authorNote=null, correspAuthorsNote=
E-mail:
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目的 探讨C反应蛋白/白蛋白比值(CAR)与重症肺炎患者病情严重程度的关系及其对28 d死亡风险的预测价值。方法 选择2020年1月－2022年1月阜阳市人民医院收治的152例重症肺炎患者作为研究对象进行回顾性分析。收集患者年龄、性别等临床资料，依据病情严重程度分为非危重症组(n=51)、危重症组(n=63)与极危重症组(n=38)。采用Pearson相关性分析CAR与病情严重程度[以急性生理学和慢性健康状况评价Ⅱ(APACHE Ⅱ)评分判定]的相关性，多因素logistic回归分析筛选病情严重程度的独立影响因素。依据患者治疗28 d后的存活状况分为存活组(n=107)与死亡组(n=45)。按CAR从低到高等分为五分位数组(Q1－Q5)，采用多因素logistic回归分析探讨CAR与重症肺炎患者28 d死亡风险的相关性，并采用限制性立方样条(RCS)模型分析CAR与死亡风险的剂量-反应关系。采用受试者操作特征(ROC)曲线分析CAR及相关指标对患者死亡风险的预测价值。结果 CAR与APACHE Ⅱ评分呈明显正相关(r=0.716，P<0.05)。中性粒细胞/淋巴细胞比值(NLR)、血乳酸(Lac)、CAR高是重症肺炎患者病情严重程度的独立危险因素(P<0.05)。校正混杂因素后，随着CAR的升高，患者死亡风险增高(P<0.05)。对筛选的混杂因素进行亚组分析发现，在不同的APACHE Ⅱ评分、GCS评分、SOFA评分、白细胞计数(WBC)、中性粒细胞计数(NEU)、红细胞分布宽度(RDW)、降钙素原(PCT)、Lac间，CAR与重症肺炎患者28 d死亡风险的相关性稳定存在，且与NLR、Lac亚组间存在交互作用(P<0.05)。RCS模型显示，CAR与不同性别重症肺炎患者28 d死亡风险均不存在非线性剂量-反应关系。ROC曲线分析显示，CAR、Lac、NLR对重症肺炎患者28 d死亡风险的预测价值较好，三者联合的预测效能明显高于单一指标。结论 重症肺炎患者CAR与病情进展及预后结局之间存在密切联系，可作为评估病情严重程度的新指标，有助于预测患者的死亡风险。

, correspAuthors=李东风, authorNote=null, correspAuthorsNote=
李东风，E-mail：
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付玉茹，硕士研究生，主治医师，主要从事呼吸重症方面的研究

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付玉茹，硕士研究生，主治医师，主要从事呼吸重症方面的研究

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付玉茹，硕士研究生，主治医师，主要从事呼吸重症方面的研究

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Pathobiology, 2021, 88(1): 15-27., articleTitle=The impact of COVID-19 disease on platelets and coagulation, refAbstract=null)], funds=[Fund(id=1194634118936895735, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, awardId=FK202081003, language=EN, fundingSource=Fuyang City Self Foundation Science and Technology Plan Project(FK202081003), fundOrder=null, country=null), Fund(id=1194634118995615992, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, awardId=FK202081003, language=CN, fundingSource=阜阳市自筹经费科技计划项目(FK202081003), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1194634114750980296, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, xref=null, ext=[AuthorCompanyExt(id=1194634114759368905, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, companyId=1194634114750980296, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Critical Care Medicine, Fuyang People's Hospital, Fuyang, Anhui 236000, China), AuthorCompanyExt(id=1194634114771951818, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, companyId=1194634114750980296, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=阜阳市人民医院重症医学科，安徽阜阳 236000)])], figs=[ArticleFig(id=1194634117481472231, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=EN, label=Fig.1, caption=Dose-response relationship between CAR and 28-day mortality in patients with severe pneumonia, figureFileSmall=QOHSwo3Tcgb/9t5CGGdzRg==, figureFileBig=+KTB91+tBQZKKaEkF1P7ag==, tableContent=null), ArticleFig(id=1194634117548581096, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=CN, label=图1, caption=CAR与重症肺炎患者28 d死亡的剂量-反应关系

CAR. C反应蛋白/白蛋白比值

, figureFileSmall=QOHSwo3Tcgb/9t5CGGdzRg==, figureFileBig=+KTB91+tBQZKKaEkF1P7ag==, tableContent=null), ArticleFig(id=1194634117636661481, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=EN, label=Tab.1, caption=

Comparison of clinical data of severe pneumonia patients with different degrees of illness

, figureFileSmall=null, figureFileBig=null, tableContent=
项目非危重症组(n=51)危重症组(n=63)极危重症组(n=38)F/χ2P
年龄(岁, $\bar{x}±s$)67.8±3.168.0±3.568.2±2.90.1970.657
BMI(kg/m2, $\bar{x}±s$)23.69±2.8423.75±2.9623.73±3.250.0660.797
收缩压(mmHg, $\bar{x}±s$)129.52±18.76129.83±21.47130.19±19.830.0090.925
舒张压(mmHg, $\bar{x}±s$)83.19±6.2583.05±7.3982.94±7.340.1840.668
心率(次/min, $\bar{x}±s$)109.52±13.14110.95±15.94112.43±16.020.0630.801
性别[例(%)]0.2040.651
男24(47.1)31(49.2)19(50.0)
女27(52.9)32(50.8)19(50.0)
受教育水平[例(%)]0.0030.957
本科及以上10(19.6)12(19.1)7(18.4)
高中、专科19(37.3)23(36.5)14(36.8)
初中及以下22(43.1)28(44.4)17(44.8)
家庭月收入[例(%)]0.6550.418
<2000元11(21.6)13(20.6)8(21.1)
2000~5000元26(51.0)32(50.8)19(50.0)
>5000元14(27.4)18(28.6)11(28.9)
吸烟史[例(%)]0.4240.515
是22(43.1)28(44.4)17(44.7)
否29(56.9)35(55.6)21(55.3)
饮酒史[例(%)]0.0700.792
是20(39.2)25(39.7)15(39.5)
否31(60.8)38(60.3)23(60.5)
高血压史[例(%)]0.0000.995
是18(35.3)22(34.9)14(36.8)
否33(64.7)41(65.1)24(63.2)
糖尿病史[例(%)]0.6370.425
是13(25.5)16(25.4)10(26.3)
否38(74.5)47(74.6)28(73.7)
冠心病史[例(%)]0.1270.721
是14(27.5)17(27.0)10(26.3)
否37(72.5)46(73.0)28(73.7)
慢性阻塞性肺疾病史[例(%)]0.0030.958
是9(17.7)11(17.5)9(23.7)
否42(82.3)52(82.5)29(76.3)
GCS评分(分, $\bar{x}±s$)12.65±4.259.90±3.36(1)8.14±3.78(1)(2)10.791<0.001
SOFA评分(分, $\bar{x}±s$)10.98±4.5611.23±3.84(1)13.57±3.92(1)(2)17.299<0.001
TC(mmol/L, $\bar{x}±s$)4.40±1.374.40±1.394.41±1.280.3280.744
TG(mmol/L, $\bar{x}±s$)1.71±0.541.70±0.571.72±0.600.0190.984
LDL-C(mmol/L, $\bar{x}±s$)2.84±0.482.85±0.492.85±0.570.2310.891
HDL-C(mmol/L, $\bar{x}±s$)1.13±0.091.13±0.101.14±0.120.0380.970
FPG(mmol/L, $\bar{x}±s$)6.06±0.716.07±0.726.07±0.680.0880.930
HbA1c(%, $\bar{x}±s$)6.00±0.156.01±0.206.02±0.160.0800.937
WBC(×109/L, $\bar{x}±s$)15.24±3.4217.65±4.29(1)22.19±5.37(1)(2)3.0170.003
NEU(×109/L, $\bar{x}±s$)7.58±1.699.92±1.47(1)11.84±2.70(1)(2)2.6000.011
GR(%, $\bar{x}±s$)77.26±9.8977.33±8.7378.16±7.980.2150.643
LYM(×109/L, $\bar{x}±s$)1.52±0.391.54±0.421.60±0.450.3360.562
RDW($\bar{x}±s$)13.89±2.3615.23±2.74(1)18.47±3.56(1)(2)4.8620.027
CRP(mg/L, $\bar{x}±s$)72.56±8.7598.76±9.23(1)132.53±10.29(1)(2)7.6290.006
ALB(g/L, $\bar{x}±s$)34.10±3.4230.45±2.98(1)28.36±3.15(1)(2)5.046<0.001
CAR($\bar{x}±s$)0.56±0.051.58±0.22(1)2.05±0.34(1)(2)9.503<0.001
PCT(ng/ml, $\bar{x}±s$)0.28±0.080.35±0.10(1)0.44±0.12(1)(2)4.738<0.001
Scr(μmol/L, $\bar{x}±s$)85.27±9.8986.37±9.2187.46±8.731.6470.098
Hcy(μmol/L, $\bar{x}±s$)16.24±2.3316.29±2.4016.33±2.290.1580.875
BUN(mmol/L, $\bar{x}±s$)6.00±1.876.01±1.946.03±1.980.1080.914
UA(μmol/L, $\bar{x}±s$)345.48±65.74345.63±69.05346.71±72.360.5780.567
PLT(×109/L, $\bar{x}±s$)193.39±20.98193.70±21.43194.34±21.220.3440.732
Hb(g/L, $\bar{x}±s$)110.67±9.87110.69±9.96111.05±9.350.0610.951
FIB(g/L, $\bar{x}±s$)3.60±0.933.62±0.863.64±1.000.2340.815
ALT(U/L, $\bar{x}±s$)27.31±7.1627.58±7.2428.19±8.450.1990.842
AST(U/L, $\bar{x}±s$)34.24±2.8334.73±2.9834.57±3.080.8990.370
NLR($\bar{x}±s$)4.33±1.155.28±1.39(1)7.36±2.03(1)(2)8.995<0.001
D-D(mg/L, $\bar{x}±s$)1.49±0.421.48±0.271.48±0.301.1710.244
Lac(mmol/L, $\bar{x}±s$)4.24±0.114.58±0.09(1)4.96±0.13(1)(2)2.7160.007
OI(mmHg, $\bar{x}±s$)192.72±13.76185.62±17.39(1)154.53±12.47(1)(2)8.995<0.001
), ArticleFig(id=1194634117762490602, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=CN, label=表1, caption=

不同病情严重程度重症肺炎患者的临床资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目非危重症组(n=51)危重症组(n=63)极危重症组(n=38)F/χ2P
年龄(岁, $\bar{x}±s$)67.8±3.168.0±3.568.2±2.90.1970.657
BMI(kg/m2, $\bar{x}±s$)23.69±2.8423.75±2.9623.73±3.250.0660.797
收缩压(mmHg, $\bar{x}±s$)129.52±18.76129.83±21.47130.19±19.830.0090.925
舒张压(mmHg, $\bar{x}±s$)83.19±6.2583.05±7.3982.94±7.340.1840.668
心率(次/min, $\bar{x}±s$)109.52±13.14110.95±15.94112.43±16.020.0630.801
性别[例(%)]0.2040.651
男24(47.1)31(49.2)19(50.0)
女27(52.9)32(50.8)19(50.0)
受教育水平[例(%)]0.0030.957
本科及以上10(19.6)12(19.1)7(18.4)
高中、专科19(37.3)23(36.5)14(36.8)
初中及以下22(43.1)28(44.4)17(44.8)
家庭月收入[例(%)]0.6550.418
<2000元11(21.6)13(20.6)8(21.1)
2000~5000元26(51.0)32(50.8)19(50.0)
>5000元14(27.4)18(28.6)11(28.9)
吸烟史[例(%)]0.4240.515
是22(43.1)28(44.4)17(44.7)
否29(56.9)35(55.6)21(55.3)
饮酒史[例(%)]0.0700.792
是20(39.2)25(39.7)15(39.5)
否31(60.8)38(60.3)23(60.5)
高血压史[例(%)]0.0000.995
是18(35.3)22(34.9)14(36.8)
否33(64.7)41(65.1)24(63.2)
糖尿病史[例(%)]0.6370.425
是13(25.5)16(25.4)10(26.3)
否38(74.5)47(74.6)28(73.7)
冠心病史[例(%)]0.1270.721
是14(27.5)17(27.0)10(26.3)
否37(72.5)46(73.0)28(73.7)
慢性阻塞性肺疾病史[例(%)]0.0030.958
是9(17.7)11(17.5)9(23.7)
否42(82.3)52(82.5)29(76.3)
GCS评分(分, $\bar{x}±s$)12.65±4.259.90±3.36(1)8.14±3.78(1)(2)10.791<0.001
SOFA评分(分, $\bar{x}±s$)10.98±4.5611.23±3.84(1)13.57±3.92(1)(2)17.299<0.001
TC(mmol/L, $\bar{x}±s$)4.40±1.374.40±1.394.41±1.280.3280.744
TG(mmol/L, $\bar{x}±s$)1.71±0.541.70±0.571.72±0.600.0190.984
LDL-C(mmol/L, $\bar{x}±s$)2.84±0.482.85±0.492.85±0.570.2310.891
HDL-C(mmol/L, $\bar{x}±s$)1.13±0.091.13±0.101.14±0.120.0380.970
FPG(mmol/L, $\bar{x}±s$)6.06±0.716.07±0.726.07±0.680.0880.930
HbA1c(%, $\bar{x}±s$)6.00±0.156.01±0.206.02±0.160.0800.937
WBC(×109/L, $\bar{x}±s$)15.24±3.4217.65±4.29(1)22.19±5.37(1)(2)3.0170.003
NEU(×109/L, $\bar{x}±s$)7.58±1.699.92±1.47(1)11.84±2.70(1)(2)2.6000.011
GR(%, $\bar{x}±s$)77.26±9.8977.33±8.7378.16±7.980.2150.643
LYM(×109/L, $\bar{x}±s$)1.52±0.391.54±0.421.60±0.450.3360.562
RDW($\bar{x}±s$)13.89±2.3615.23±2.74(1)18.47±3.56(1)(2)4.8620.027
CRP(mg/L, $\bar{x}±s$)72.56±8.7598.76±9.23(1)132.53±10.29(1)(2)7.6290.006
ALB(g/L, $\bar{x}±s$)34.10±3.4230.45±2.98(1)28.36±3.15(1)(2)5.046<0.001
CAR($\bar{x}±s$)0.56±0.051.58±0.22(1)2.05±0.34(1)(2)9.503<0.001
PCT(ng/ml, $\bar{x}±s$)0.28±0.080.35±0.10(1)0.44±0.12(1)(2)4.738<0.001
Scr(μmol/L, $\bar{x}±s$)85.27±9.8986.37±9.2187.46±8.731.6470.098
Hcy(μmol/L, $\bar{x}±s$)16.24±2.3316.29±2.4016.33±2.290.1580.875
BUN(mmol/L, $\bar{x}±s$)6.00±1.876.01±1.946.03±1.980.1080.914
UA(μmol/L, $\bar{x}±s$)345.48±65.74345.63±69.05346.71±72.360.5780.567
PLT(×109/L, $\bar{x}±s$)193.39±20.98193.70±21.43194.34±21.220.3440.732
Hb(g/L, $\bar{x}±s$)110.67±9.87110.69±9.96111.05±9.350.0610.951
FIB(g/L, $\bar{x}±s$)3.60±0.933.62±0.863.64±1.000.2340.815
ALT(U/L, $\bar{x}±s$)27.31±7.1627.58±7.2428.19±8.450.1990.842
AST(U/L, $\bar{x}±s$)34.24±2.8334.73±2.9834.57±3.080.8990.370
NLR($\bar{x}±s$)4.33±1.155.28±1.39(1)7.36±2.03(1)(2)8.995<0.001
D-D(mg/L, $\bar{x}±s$)1.49±0.421.48±0.271.48±0.301.1710.244
Lac(mmol/L, $\bar{x}±s$)4.24±0.114.58±0.09(1)4.96±0.13(1)(2)2.7160.007
OI(mmHg, $\bar{x}±s$)192.72±13.76185.62±17.39(1)154.53±12.47(1)(2)8.995<0.001
), ArticleFig(id=1194634117846376683, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=EN, label=Tab.2, caption=

The assignment status of the included independent variables

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
GCS评分>10分=1, ≤10分=0
SOFA评分>11分=1, ≤11分=0
WBC>18.36×109/L=1, ≤18.36×109/L=0
NEU>10.35×109/L=1, ≤10.35×109/L=0
RDW>15.27=1, ≤15.27=0
CAR>1.50=1, ≤1.50=0
PCT>0.36 ng/ml=1, ≤0.36 ng/ml=0
NLR>5.24=1, ≤5.24=0
Lac>4.55 mmol/L=1, ≤4.55 mmol/L=0
OI>185.75 mmHg=1, ≤185.75 mmHg=0
), ArticleFig(id=1194634117926068460, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=CN, label=表2, caption=

自变量的赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
GCS评分>10分=1, ≤10分=0
SOFA评分>11分=1, ≤11分=0
WBC>18.36×109/L=1, ≤18.36×109/L=0
NEU>10.35×109/L=1, ≤10.35×109/L=0
RDW>15.27=1, ≤15.27=0
CAR>1.50=1, ≤1.50=0
PCT>0.36 ng/ml=1, ≤0.36 ng/ml=0
NLR>5.24=1, ≤5.24=0
Lac>4.55 mmol/L=1, ≤4.55 mmol/L=0
OI>185.75 mmHg=1, ≤185.75 mmHg=0
), ArticleFig(id=1194634118039314669, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=EN, label=Tab.3, caption=

Multivariate analysis of severe pneumonia patients' illness

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βSEWald χ2OR95%CIP
GCS评分-1.0941.1120.9670.3350.458~0.7810.069
SOFA评分0.9280.8741.3622.5290.356~7.9210.055
WBC0.3743.75306721.4530.256~5.6950.174
NEU0.9210.7561.4322.5120.782~3.4270.098
RDW1.0560.9833.5822.8740.439~3.2220.136
CAR1.1390.6772.1763.1231.568~7.4390.003
PCT0.9830.2612.9652.6730.428~3.1890.081
NLR0.9310.6382.1312.5381.278~5.4680.017
Lac1.3591.0181.7883.8941.952~4.9310.024
OI-0.6200.5151.4490.5380.278~1.7680.153
), ArticleFig(id=1194634118106423534, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=CN, label=表3, caption=

重症肺炎患者病情严重程度的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βSEWald χ2OR95%CIP
GCS评分-1.0941.1120.9670.3350.458~0.7810.069
SOFA评分0.9280.8741.3622.5290.356~7.9210.055
WBC0.3743.75306721.4530.256~5.6950.174
NEU0.9210.7561.4322.5120.782~3.4270.098
RDW1.0560.9833.5822.8740.439~3.2220.136
CAR1.1390.6772.1763.1231.568~7.4390.003
PCT0.9830.2612.9652.6730.428~3.1890.081
NLR0.9310.6382.1312.5381.278~5.4680.017
Lac1.3591.0181.7883.8941.952~4.9310.024
OI-0.6200.5151.4490.5380.278~1.7680.153
), ArticleFig(id=1194634118219669743, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=EN, label=Tab.4, caption=

Comparison of clinical data of severe pneumonia patients with different prognoses

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

存活组

(n=107)

死亡组

(n=45)

t/χ2P
年龄(岁, $\bar{x}±s$)67.8±2.968.2±2.80.3500.727
BMI(kg/m2, $\bar{x}±s$)23.74±3.0823.76±3.150.0360.971
收缩压(mmHg, $\bar{x}±s$)129.32±18.56130.86±19.300.3280.744
舒张压(mmHg, $\bar{x}±s$)82.85±6.9883.57±7.340.0190.984
心率(次/min, $\bar{x}±s$)109.93±15.36111.84±14.570.5120.610
性别[例(%)]0.0000.992
男52(48.6)22(48.9)
女55(51.4)23(51.1)
受教育水平[例(%)]0.4110.682
本科及以上21(19.6)8(17.8)
高中、专科39(36.5)17(37.8)
初中及以下47(43.9)20(44.4)
家庭月收入[例(%)]0.0020.964
<2000元23(21.5)9(20.0)
2000~5000元54(50.5)23(51.1)
>5000元30(28.0)13(28.9)
吸烟[例(%)]0.1210.728
是47(43.9)20(44.4)
否60(56.1)25(55.6)
饮酒[例(%)]0.3560.551
是42(39.2)18(40.0)
否65(60.8)27(60.0)
高血压[例(%)]0.1490.700
是38(35.5)16(35.6)
否69(64.5)29(64.4)
糖尿病[例(%)]0.5440.461
是27(25.2)12(26.7)
否80(74.8)33(73.3)
冠心病[例(%)]0.0740.786
是29(27.1)12(26.7)
否78(72.9)33(73.3)
慢性阻塞性肺疾病[例(%)]0.2930.588
是21(19.6)8(17.8)
否86(80.4)37(82.2)
APACHE Ⅱ评分(分, $\bar{x}±s$)19.14±4.2824.75±5.326.850<0.001
GCS评分(分, $\bar{x}±s$)12.26±3.159.69±3.399.541<0.001
SOFA评分(分, $\bar{x}±s$)11.23±3.8412.98±4.562.4230.017
TC(mmol/L, $\bar{x}±s$)4.40±1.304.41±1.291.0310.307
TG(mmol/L, $\bar{x}±s$)1.71±0.581.72±0.610.2650.791
LDL-C(mmol/L, $\bar{x}±s$)2.84±0.522.85±0.530.8590.391
HDL-C(mmol/L, $\bar{x}±s$)1.13±0.111.14±0.100.0010.977
FPG(mmol/L, $\bar{x}±s$)6.06±0.656.07±0.690.0020.969
HbA1c(%, $\bar{x}±s$)6.02±0.206.01±0.170.4750.629
WBC(×109/L, $\bar{x}±s$)15.42±4.6222.16±5.237.892<0.001
NEU(×109/L, $\bar{x}±s$)7.71±5.6910.84±6.702.9340.004
GR(%, $\bar{x}±s$)77.46±8.7378.27±9.890.5020.617
LYM(×109/L, $\bar{x}±s$)1.61±0.421.52±0.391.2310.220
RDW($\bar{x}±s$)15.46±8.7318.27±9.892.0660.040
CRP(mg/L, $\bar{x}±s$)17.28±10.3833.66±36.174.299<0.001
ALB(g/L, $\bar{x}±s$)34.20±2.0428.10±3.4213.601<0.001
CAR($\bar{x}±s$)0.53±0.472.06±1.519.481<0.001
PCT(ng/ml, $\bar{x}±s$)4.24±2.499.21±3.0810.451<0.001
Scr(μmol/L, $\bar{x}±s$)86.23±8.6786.54±9.320.0980.903
Hcy(μmol/L, $\bar{x}±s$)16.32±2.5616.30±2.470.1370.975
BUN(mmol/L, $\bar{x}±s$)6.01±1.826.02±1.790.0030.960
UA(μmol/L, $\bar{x}±s$)346.22±69.47347.39±68.450.0020.966
PLT(×109/L, $\bar{x}±s$)133.28±33.21125.96±30.121.2740.205
Hb(g/L, $\bar{x}±s$)110.97±10.64111.25±11.260.3210.736
FIB(g/L, $\bar{x}±s$)3.64±0.563.66±0.670.0740.921
ALT(U/L, $\bar{x}±s$)50.98±16.8452.12±16.970.3800.704
AST(U/L, $\bar{x}±s$)49.79±17.2152.28±16.370.8260.410
NLR($\bar{x}±s$)4.28±2.097.33±2.457.797<0.001
D-D(mg/L, $\bar{x}±s$)1.47±0.321.49±0.380.9830.328
Lac(mmol/L, $\bar{x}±s$)4.28±0.094.94±0.1138.575<0.001
OI(mmHg, $\bar{x}±s$)197.62±17.39142.72±13.7618.831<0.001
), ArticleFig(id=1194634118303555824, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=CN, label=表4, caption=

不同预后重症肺炎患者的临床资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

存活组

(n=107)

死亡组

(n=45)

t/χ2P
年龄(岁, $\bar{x}±s$)67.8±2.968.2±2.80.3500.727
BMI(kg/m2, $\bar{x}±s$)23.74±3.0823.76±3.150.0360.971
收缩压(mmHg, $\bar{x}±s$)129.32±18.56130.86±19.300.3280.744
舒张压(mmHg, $\bar{x}±s$)82.85±6.9883.57±7.340.0190.984
心率(次/min, $\bar{x}±s$)109.93±15.36111.84±14.570.5120.610
性别[例(%)]0.0000.992
男52(48.6)22(48.9)
女55(51.4)23(51.1)
受教育水平[例(%)]0.4110.682
本科及以上21(19.6)8(17.8)
高中、专科39(36.5)17(37.8)
初中及以下47(43.9)20(44.4)
家庭月收入[例(%)]0.0020.964
<2000元23(21.5)9(20.0)
2000~5000元54(50.5)23(51.1)
>5000元30(28.0)13(28.9)
吸烟[例(%)]0.1210.728
是47(43.9)20(44.4)
否60(56.1)25(55.6)
饮酒[例(%)]0.3560.551
是42(39.2)18(40.0)
否65(60.8)27(60.0)
高血压[例(%)]0.1490.700
是38(35.5)16(35.6)
否69(64.5)29(64.4)
糖尿病[例(%)]0.5440.461
是27(25.2)12(26.7)
否80(74.8)33(73.3)
冠心病[例(%)]0.0740.786
是29(27.1)12(26.7)
否78(72.9)33(73.3)
慢性阻塞性肺疾病[例(%)]0.2930.588
是21(19.6)8(17.8)
否86(80.4)37(82.2)
APACHE Ⅱ评分(分, $\bar{x}±s$)19.14±4.2824.75±5.326.850<0.001
GCS评分(分, $\bar{x}±s$)12.26±3.159.69±3.399.541<0.001
SOFA评分(分, $\bar{x}±s$)11.23±3.8412.98±4.562.4230.017
TC(mmol/L, $\bar{x}±s$)4.40±1.304.41±1.291.0310.307
TG(mmol/L, $\bar{x}±s$)1.71±0.581.72±0.610.2650.791
LDL-C(mmol/L, $\bar{x}±s$)2.84±0.522.85±0.530.8590.391
HDL-C(mmol/L, $\bar{x}±s$)1.13±0.111.14±0.100.0010.977
FPG(mmol/L, $\bar{x}±s$)6.06±0.656.07±0.690.0020.969
HbA1c(%, $\bar{x}±s$)6.02±0.206.01±0.170.4750.629
WBC(×109/L, $\bar{x}±s$)15.42±4.6222.16±5.237.892<0.001
NEU(×109/L, $\bar{x}±s$)7.71±5.6910.84±6.702.9340.004
GR(%, $\bar{x}±s$)77.46±8.7378.27±9.890.5020.617
LYM(×109/L, $\bar{x}±s$)1.61±0.421.52±0.391.2310.220
RDW($\bar{x}±s$)15.46±8.7318.27±9.892.0660.040
CRP(mg/L, $\bar{x}±s$)17.28±10.3833.66±36.174.299<0.001
ALB(g/L, $\bar{x}±s$)34.20±2.0428.10±3.4213.601<0.001
CAR($\bar{x}±s$)0.53±0.472.06±1.519.481<0.001
PCT(ng/ml, $\bar{x}±s$)4.24±2.499.21±3.0810.451<0.001
Scr(μmol/L, $\bar{x}±s$)86.23±8.6786.54±9.320.0980.903
Hcy(μmol/L, $\bar{x}±s$)16.32±2.5616.30±2.470.1370.975
BUN(mmol/L, $\bar{x}±s$)6.01±1.826.02±1.790.0030.960
UA(μmol/L, $\bar{x}±s$)346.22±69.47347.39±68.450.0020.966
PLT(×109/L, $\bar{x}±s$)133.28±33.21125.96±30.121.2740.205
Hb(g/L, $\bar{x}±s$)110.97±10.64111.25±11.260.3210.736
FIB(g/L, $\bar{x}±s$)3.64±0.563.66±0.670.0740.921
ALT(U/L, $\bar{x}±s$)50.98±16.8452.12±16.970.3800.704
AST(U/L, $\bar{x}±s$)49.79±17.2152.28±16.370.8260.410
NLR($\bar{x}±s$)4.28±2.097.33±2.457.797<0.001
D-D(mg/L, $\bar{x}±s$)1.47±0.321.49±0.380.9830.328
Lac(mmol/L, $\bar{x}±s$)4.28±0.094.94±0.1138.575<0.001
OI(mmHg, $\bar{x}±s$)197.62±17.39142.72±13.7618.831<0.001
), ArticleFig(id=1194634118441967857, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=EN, label=Tab.5, caption=

The relationship between CAR and 28-day mortality in severe pneumonia patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量未校正模型模型1模型2模型3模型4模型5
P趋势<0.001<0.001<0.001<0.001<0.001<0.001
CAR1.53(1.06~2.75)1.62(1.04~2.87)1.58(1.20~1.99)1.56(1.24~2.47)1.59(1.07~1.96)1.63(1.07~1.95)
CAR二分类
≤1.25111111
>1.251.47(1.21~1.89)1.74(1.25~2.36)1.69(1.34~2.87)1.63(1.52~2.69)1.58(1.20~1.76)1.60(1.18~1.84)
CAR五分类
Q1(<0.50)111111
Q2(0.50~0.83)1.64(1.42~1.85)1.73(1.54~1.96)1.81(1.63~2.02)1.89(1.69~2.13)1.64(1.42~1.85)1.73(1.54~1.96)
Q3(0.83~1.59)1.66(1.45~1.88)1.76(1.57~1.99)1.84(1.66~2.07)1.92(1.71~2.18)1.66(1.45~1.88)1.76(1.57~1.99)
Q4(1.59~2.05)1.58(1.33~1.74)1.61(1.42~1.83)1.75(1.50~1.86)1.83(1.64~2.04)1.58(1.33~1.74)1.61(1.42~1.83)
Q5(>2.05)1.46(1.03~1.94)1.53(1.31~1.67)1.84(1.47~2.03)1.57(1.25~1.96)1.55(1.39~1.77)1.52(1.28~1.85)
), ArticleFig(id=1194634118504882418, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=CN, label=表5, caption=

CAR与重症肺炎患者28 d死亡的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
变量未校正模型模型1模型2模型3模型4模型5
P趋势<0.001<0.001<0.001<0.001<0.001<0.001
CAR1.53(1.06~2.75)1.62(1.04~2.87)1.58(1.20~1.99)1.56(1.24~2.47)1.59(1.07~1.96)1.63(1.07~1.95)
CAR二分类
≤1.25111111
>1.251.47(1.21~1.89)1.74(1.25~2.36)1.69(1.34~2.87)1.63(1.52~2.69)1.58(1.20~1.76)1.60(1.18~1.84)
CAR五分类
Q1(<0.50)111111
Q2(0.50~0.83)1.64(1.42~1.85)1.73(1.54~1.96)1.81(1.63~2.02)1.89(1.69~2.13)1.64(1.42~1.85)1.73(1.54~1.96)
Q3(0.83~1.59)1.66(1.45~1.88)1.76(1.57~1.99)1.84(1.66~2.07)1.92(1.71~2.18)1.66(1.45~1.88)1.76(1.57~1.99)
Q4(1.59~2.05)1.58(1.33~1.74)1.61(1.42~1.83)1.75(1.50~1.86)1.83(1.64~2.04)1.58(1.33~1.74)1.61(1.42~1.83)
Q5(>2.05)1.46(1.03~1.94)1.53(1.31~1.67)1.84(1.47~2.03)1.57(1.25~1.96)1.55(1.39~1.77)1.52(1.28~1.85)
), ArticleFig(id=1194634118597157107, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=EN, label=Tab.6, caption=

Subgroup analysis of the correlation between CAR and 28-day mortality risk in patients with severe pneumonia

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组CAR五分位数组P趋势P交互
Q1组Q2组Q3组Q4组Q5组
APACHE Ⅱ评分(分)0.753
≤2011.18(0.34~1.22)1.36(0.61~1.49)1.54(0.78~1.65)1.67(0.94~1.71)0.058
>2011.84(1.63~2.12)1.90(1.73~2.11)2.07(1.90~2.21)2.14(1.99~2.35)0.025
GCS评分(分)0.925
≤1012.05(1.81~2.37)2.13(1.91~2.45)2.34(2.12~2.55)2.41(2.18~2.72)0.039
>1011.05(0.75~1.73)1.29(0.84~1.41)1.34(0.95~1.52)1.45(1.14~1.61)0.067
SOFA评分(分)0.169
≤1111.03(0.96~1.15)1.12(0.75~1.37)1.28(0.90~1.49)1.36(0.98~1.47)0.074
>1111.47(1.21~1.89)1.54(1.25~2.36)1.69(1.34~2.87)1.73(1.52~2.69)0.045
WBC(×109/L)0.095
≤18.3611.16(0.93~1.34)1.23(0.91~1.47)1.34(0.87~1.53)1.57(0.95~1.96)0.097
>18.3611.58(1.33~1.74)1.61(1.42~1.83)1.75(1.50~1.86)1.83(1.64~2.04)0.036
NEU(×109/L)0.178
≤10.3511.20(0.75~1.35)1.31(0.94~1.52)1.45(0.89~1.61)1.56(0.97~1.84)0.085
>10.3511.56(1.25~1.78)1.69(1.35~1.87)1.78(1.43~1.89)1.84(1.35~1.92)0.034
RDW0.225
≤15.2711.18(0.87~1.36)1.22(0.80~1.47)1.30(0.98~1.55)1.54(0.76~1.68)0.172
>15.2711.76(1.57~2.06)1.92(1.80~2.27)1.92(1.67~2.15)1.98(1.78~2.15)0.048
PCT(ng/ml)0.074
≤0.3611.09(0.38~1.65)1.20(0.63~1.75)1.37(0.86~1.78)1.37(0.92~1.67)0.162
>0.3611.59(1.42~1.81)1.78(1.54~1.92)1.86(1.71~1.99)1.94(1.78~2.15)0.025
NLR0.043
≤5.2410.98(0.26~1.43)1.03(0.87~1.46)1.18(0.75~1.83)1.26(0.80~1.89)0.094
>5.2411.64(1.48~1.87)1.73(1.61~1.87)1.76(1.54~1.93)1.82(1.67~2.06)0.037
Lac(mmol/L)0.048
≤4.5510.99(0.76~1.73)1.02(0.67~1.86)1.10(0.82~1.79)1.25(0.70~1.85)0.163
>4.5511.61(1.45~1.86)1.68(1.50~1.90)1.71(1.52~1.97)1.80(1.62~1.94)0.040
OI(mmHg)0.185
≤185.7510.88(0.59~2.06)0.75(0.42~1.29)0.67(0.41~1.30)0.53(0.22~1.29)0.326
>185.7510.67(0.55~1.21)0.51(0.34~1.33)0.43(0.36~1.41)0.39(0.16~1.40)0.059
), ArticleFig(id=1194634118672654580, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=CN, label=表6, caption=

CAR与重症肺炎患者28 d死亡风险相关性的亚组分析

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组CAR五分位数组P趋势P交互
Q1组Q2组Q3组Q4组Q5组
APACHE Ⅱ评分(分)0.753
≤2011.18(0.34~1.22)1.36(0.61~1.49)1.54(0.78~1.65)1.67(0.94~1.71)0.058
>2011.84(1.63~2.12)1.90(1.73~2.11)2.07(1.90~2.21)2.14(1.99~2.35)0.025
GCS评分(分)0.925
≤1012.05(1.81~2.37)2.13(1.91~2.45)2.34(2.12~2.55)2.41(2.18~2.72)0.039
>1011.05(0.75~1.73)1.29(0.84~1.41)1.34(0.95~1.52)1.45(1.14~1.61)0.067
SOFA评分(分)0.169
≤1111.03(0.96~1.15)1.12(0.75~1.37)1.28(0.90~1.49)1.36(0.98~1.47)0.074
>1111.47(1.21~1.89)1.54(1.25~2.36)1.69(1.34~2.87)1.73(1.52~2.69)0.045
WBC(×109/L)0.095
≤18.3611.16(0.93~1.34)1.23(0.91~1.47)1.34(0.87~1.53)1.57(0.95~1.96)0.097
>18.3611.58(1.33~1.74)1.61(1.42~1.83)1.75(1.50~1.86)1.83(1.64~2.04)0.036
NEU(×109/L)0.178
≤10.3511.20(0.75~1.35)1.31(0.94~1.52)1.45(0.89~1.61)1.56(0.97~1.84)0.085
>10.3511.56(1.25~1.78)1.69(1.35~1.87)1.78(1.43~1.89)1.84(1.35~1.92)0.034
RDW0.225
≤15.2711.18(0.87~1.36)1.22(0.80~1.47)1.30(0.98~1.55)1.54(0.76~1.68)0.172
>15.2711.76(1.57~2.06)1.92(1.80~2.27)1.92(1.67~2.15)1.98(1.78~2.15)0.048
PCT(ng/ml)0.074
≤0.3611.09(0.38~1.65)1.20(0.63~1.75)1.37(0.86~1.78)1.37(0.92~1.67)0.162
>0.3611.59(1.42~1.81)1.78(1.54~1.92)1.86(1.71~1.99)1.94(1.78~2.15)0.025
NLR0.043
≤5.2410.98(0.26~1.43)1.03(0.87~1.46)1.18(0.75~1.83)1.26(0.80~1.89)0.094
>5.2411.64(1.48~1.87)1.73(1.61~1.87)1.76(1.54~1.93)1.82(1.67~2.06)0.037
Lac(mmol/L)0.048
≤4.5510.99(0.76~1.73)1.02(0.67~1.86)1.10(0.82~1.79)1.25(0.70~1.85)0.163
>4.5511.61(1.45~1.86)1.68(1.50~1.90)1.71(1.52~1.97)1.80(1.62~1.94)0.040
OI(mmHg)0.185
≤185.7510.88(0.59~2.06)0.75(0.42~1.29)0.67(0.41~1.30)0.53(0.22~1.29)0.326
>185.7510.67(0.55~1.21)0.51(0.34~1.33)0.43(0.36~1.41)0.39(0.16~1.40)0.059
), ArticleFig(id=1194634118748152053, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=EN, label=Tab.7, caption=

The predictive value of CAR and related factors on 28-day mortality in patients with severe pneumonia

, figureFileSmall=null, figureFileBig=null, tableContent=
指标AUC95%CIP敏感度(%)特异度(%)
CAR0.7900.721~0.822<0.00186.1079.20
Lac0.7050.633~0.749<0.00180.5773.65
NLR0.7140.636~0.736<0.00181.6574.28
三者联合0.8350.795~0.868<0.00192.5391.65
), ArticleFig(id=1194634118811066614, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194613947077726657, language=CN, label=表7, caption=

CAR及相关因素对重症肺炎患者28 d死亡的预测价值

, figureFileSmall=null, figureFileBig=null, tableContent=
指标AUC95%CIP敏感度(%)特异度(%)
CAR0.7900.721~0.822<0.00186.1079.20
Lac0.7050.633~0.749<0.00180.5773.65
NLR0.7140.636~0.736<0.00181.6574.28
三者联合0.8350.795~0.868<0.00192.5391.65
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C反应蛋白/白蛋白比值与重症肺炎患者病情严重程度的关系及其对28 d死亡风险的预测价值
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付玉茹 , 孙振康 , 刘成 , 李东风 *
解放军医学杂志 | 临床研究 2025,50(3): 309-317
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解放军医学杂志 | 临床研究 2025, 50(3): 309-317
C反应蛋白/白蛋白比值与重症肺炎患者病情严重程度的关系及其对28 d死亡风险的预测价值
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付玉茹, 孙振康, 刘成, 李东风*
作者信息
  • 阜阳市人民医院重症医学科，安徽阜阳 236000

    • 付玉茹，硕士研究生，主治医师，主要从事呼吸重症方面的研究

通讯作者:

李东风，E-mail：
Relationship between C-reactive protein/albumin ratio and severity in patients with severe pneumonia and its predictive value for 28-day mortality risk
Yu-Ru Fu, Zhen-Kang Sun, Cheng Liu, Dong-Feng Li*
Affiliations
  • Department of Critical Care Medicine, Fuyang People's Hospital, Fuyang, Anhui 236000, China
出版时间: 2025-03-28 doi: 10.11855/j.issn.0577-7402.0345.2024.1215
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摘要
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目的 探讨C反应蛋白/白蛋白比值(CAR)与重症肺炎患者病情严重程度的关系及其对28 d死亡风险的预测价值。方法 选择2020年1月－2022年1月阜阳市人民医院收治的152例重症肺炎患者作为研究对象进行回顾性分析。收集患者年龄、性别等临床资料，依据病情严重程度分为非危重症组(n=51)、危重症组(n=63)与极危重症组(n=38)。采用Pearson相关性分析CAR与病情严重程度[以急性生理学和慢性健康状况评价Ⅱ(APACHE Ⅱ)评分判定]的相关性，多因素logistic回归分析筛选病情严重程度的独立影响因素。依据患者治疗28 d后的存活状况分为存活组(n=107)与死亡组(n=45)。按CAR从低到高等分为五分位数组(Q1－Q5)，采用多因素logistic回归分析探讨CAR与重症肺炎患者28 d死亡风险的相关性，并采用限制性立方样条(RCS)模型分析CAR与死亡风险的剂量-反应关系。采用受试者操作特征(ROC)曲线分析CAR及相关指标对患者死亡风险的预测价值。结果 CAR与APACHE Ⅱ评分呈明显正相关(r=0.716，P<0.05)。中性粒细胞/淋巴细胞比值(NLR)、血乳酸(Lac)、CAR高是重症肺炎患者病情严重程度的独立危险因素(P<0.05)。校正混杂因素后，随着CAR的升高，患者死亡风险增高(P<0.05)。对筛选的混杂因素进行亚组分析发现，在不同的APACHE Ⅱ评分、GCS评分、SOFA评分、白细胞计数(WBC)、中性粒细胞计数(NEU)、红细胞分布宽度(RDW)、降钙素原(PCT)、Lac间，CAR与重症肺炎患者28 d死亡风险的相关性稳定存在，且与NLR、Lac亚组间存在交互作用(P<0.05)。RCS模型显示，CAR与不同性别重症肺炎患者28 d死亡风险均不存在非线性剂量-反应关系。ROC曲线分析显示，CAR、Lac、NLR对重症肺炎患者28 d死亡风险的预测价值较好，三者联合的预测效能明显高于单一指标。结论 重症肺炎患者CAR与病情进展及预后结局之间存在密切联系，可作为评估病情严重程度的新指标，有助于预测患者的死亡风险。

C反应蛋白/白蛋白比值  /  重症肺炎  /  死亡风险  /  预测价值

Objective To explore the relationship between C-reactive protein/albumin ratio (CAR) and the disease severity in patients with severe pneumonia, and its predictive value for 28-day mortality risk. Methods A retrospective analysis was conducted on 152 patients with severe pneumonia admitted to Fuyang People's Hospital from January 2020 to January 2022. They were divided into non-critical illness group (n=51), critical illness group (n=63), and extremely critical illness group (n=38) based on the disease severity. The clinical data such as age and gender of patients was collected, and Pearson correlation analysis was used to explore the correlation between CAR and the severity of illness [determined by Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score]. Multivariate logistic regression was employed to identify independent influencing factors of the severity of illness. According to the survival status of patients after 28 days of treatment, they were divided into survival group (n=107) and death group (n=45). CAR was categorized into quintiles (Q1-Q5), and multivariate logistic regression analysis was conducted to explore the correlation between CAR and 28-day mortality risk in severe pneumonia patients. A restricted cubic spline (RCS) model was used to analyze the dose-response relationship between CAR and mortality risk. The predictive value of CAR and related indicators for patient mortality risk was evaluated using the receiver operating characteristic curve (ROC). Results CAR was significantly positively correlated with the severity of the disease (APACHE Ⅱ score) (r=0.716, P<0.05). Neutrophil/lymphocyte ratio (NLR), blood lactate (Lac), and high CAR were independent risk factors for the disease severity in patients with severe pneumonia (P<0.05). After adjusting for confounding factors, the mortality risk increased with the increase of CAR (P<0.05). Subgroup analysis of the screened confounding factors revealed that the correlation between CAR and 28-day mortality risk in severe pneumonia patients remained stable across different APACHE Ⅱ scores, GCS scores, SOFA scores, white blood cell counts (WBC), neutrophils (NEU), red cell volume distribution width (RDW), procalcitonin (PCT), and Lac, with interactions observed between NLR and Lac subgroups (P<0.05). The RCS model indicated that there was no non-linear dose-response relationship between CAR and 28-day mortality risk in patients with severe pneumonia of different genders. ROC curve analysis showed that CAR, Lac, and NLR had good predictive value for 28-day mortality in severe pneumonia patients, with the combined predictive efficacy being significantly higher than that of individual indicators. Conclusion There is a close relationship between CAR and the progression and prognosis of severe pneumonia, making it a new approach to assessing the severity of illness and predicting mortality risk in patients.

C-reactive protein/albumin ratio  /  severe pneumonia  /  risk of death  /  predictive value
付玉茹, 孙振康, 刘成, 李东风. C反应蛋白/白蛋白比值与重症肺炎患者病情严重程度的关系及其对28 d死亡风险的预测价值. 解放军医学杂志, 2025 , 50 (3) : 309 -317 . DOI: 10.11855/j.issn.0577-7402.0345.2024.1215
Yu-Ru Fu, Zhen-Kang Sun, Cheng Liu, Dong-Feng Li. Relationship between C-reactive protein/albumin ratio and severity in patients with severe pneumonia and its predictive value for 28-day mortality risk[J]. Medical Journal of Chinese People’s Liberation Army, 2025 , 50 (3) : 309 -317 . DOI: 10.11855/j.issn.0577-7402.0345.2024.1215
正文
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肺炎是指由细菌、病毒或支原体引起的肺部感染性炎症[1-4]，依据其严重程度可分为轻、中、重症肺炎[5]。当患者表现出呼吸局促、意识不清、呼吸衰竭、循环障碍等症状时，可认定为重症肺炎[6-7]。重症肺炎起病迅速、进展快、并发症多[8]，病死率极高[9-10]。因此，准确评估重症肺炎病情严重程度及预后情况并采取干预措施对于降低患者的病死率意义重大。C反应蛋白/白蛋白比值(C-reactive protein/albumin ratio，CAR)是一种新型的炎症评价指标[11-13]，可用于评估呼吸道感染、急性冠脉综合征、脑梗死等多种疾病的病情严重程度及预后[14-15]，但能否作为重症肺炎预后的评价指标尚不明确。本研究以152例重症肺炎患者作为研究对象，评估CAR与病情严重程度的关系及其对28 d死亡风险的预测价值，旨在为重症肺炎的临床治疗提供参考。
1 资料与方法
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1.1 研究对象
选择2020年1月－2022年1月阜阳市人民医院收治的152例重症肺炎患者进行回顾性分析。其中男74例，女78例，年龄25~84(68.7±3.2)岁。纳入标准：(1)符合重症肺炎的诊断标准(①感染性休克经积极液体复苏后仍需血管活性药物；②需气管插管机械通气治疗)[16]；(2)年龄>18岁；(3)临床资料完整。排除标准：(1)合并严重血液系统疾病；(2)合并恶性肿瘤；(3)合并肺结核及其他支气管疾病。本研究获阜阳市人民医院伦理委员会审批(2019-07-39)。
1.2 资料收集
收集患者年龄、性别、体重指数(body mass index，BMI)、收缩压、舒张压、心率、受教育水平、家庭月收入、吸烟史、饮酒史、高血压史、糖尿病史、冠心病史、慢性阻塞性肺疾病史情况。记录患者入院首日的急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ)得分情况(总分为71分，分值越高提示病情越严重)、脓毒症相关性器官衰竭评价(sepsis-related organ failure assessment，SOFA)得分情况(总分为24分，分值越高提示病情越严重)及格拉斯哥昏迷量表(Glasgow coma scale，GCS)评分(总分为15分，分数越低提示意识障碍越重)。
采集患者入院后24 h内的外周血标本5 ml，检测总胆固醇(total cholesterol，TC)、三酰甘油(triglyceride，TG)、低密度脂蛋白胆固醇(low-density lipoprotein，LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein，HDL-C)、空腹血糖(fasting plasma glucose，FPG)、糖化血红蛋白(glycated hemoglobin，HbA1c)、糖化白蛋白(glycosylated albumin，GA)、C肽、白细胞计数(white blood cell count，WBC)、肌酐(serum creatinine，Scr)、同型半胱氨酸(homocysteine，Hcy)、血尿素氮(blood urea nitrogen，BUN)、尿酸(uric acid，UA)、血小板计数(blood platelet，PLT)、血红蛋白(haemoglobin，Hb)、D-二聚体(D-dimer，D-D)、纤维蛋白原(fibrinogen，FIB)、降钙素原(procalcitonin，PCT)、中性粒细胞计数(neutrophils，NEU)、中性粒细胞百分比(neutrophil granulocyte，GR)、淋巴细胞计数(lymphocyte，LYM)、红细胞分布宽度(red cell volume distribution width，RDW)、中性粒细胞/淋巴细胞比值(neutrophils/lymphocyte ratio，NLR)、谷丙转氨酶(alanine aminotransferase，ALT)、谷草转氨酶(aspartate aminotransferase，AST)、血乳酸(blood lactic acid，Lac)、氧合指数(oxygenation index，OI)。采用乳酸增强免疫散射比浊法测定血清C反应蛋白(C-reactive protein，CRP)水平，溴甲酚绿法测定血清白蛋白(albumin，ALB)水平，计算CAR。CAR=CRP/ALB。
1.3 分组及标准
采用APACHE Ⅱ评分判定患者的病情严重程度。非危重症：<12分；危重症：12~25分；极危重症：>25分。根据此标准将152例患者分为非危重症组(n=51)、危重症组(n=63)与极危重症组(n=38)。此外，依据治疗28 d后的存活状况将152例患者分为死亡组(n=45)与存活组(n=107)。
1.4 指标分析
比较不同病情严重程度患者一般临床指标的差异。采用Pearson相关性分析CAR与APACHE Ⅱ评分的相关性。将有统计学差异的指标作为自变量，将肺炎病情严重程度(危重症/极危重症=1，非危重症=0)作为因变量纳入多因素logistic回归分析，筛选重症肺炎患者病情严重程度的独立影响因素。此外，比较死亡组与存活组患者临床指标的差异；然后依据CAR从低到高等分为五分位数组(Q1-Q5)，采用多因素logistic回归分析探讨CAR与重症肺炎患者28 d死亡风险的相关性，同时在不同亚组中分析死亡的发生风险；并进一步分析CAR与死亡风险的剂量-反应关系，以及CAR和相关指标对患者死亡风险的预测效能。
1.5 统计学处理
采用SPSS 23.0软件进行统计分析。计量资料以$\bar{x}±s$表示，两组间比较采用t检验，多组间比较采用单因素方差分析，进一步两两比较采用LSD-t检验；计数资料以例(%)表示，组间比较采用χ2检验；采用Pearson相关性分析CAR与APACHE Ⅱ评分的相关性；采用多因素logistic回归分析筛选重症肺炎病情严重程度的影响因素。采用限制性立方样条(restricted cubic splines，RCS)模型分析CAR与死亡风险的剂量-反应关系；采用受试者操作特征(receiver operating characteristic，ROC)曲线分析CAR及相关指标对患者死亡风险的预测价值。P<0.05为差异有统计学意义。
2 结果
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2.1 不同病情严重程度患者的临床资料比较
3组间GCS评分、SOFA评分、WBC、NEU、RDW、CRP、ALB、CAR、PCT、NLR、Lac、OI差异均有统计学意义(P<0.05)。其中，与非危重症组比较，危重症组及极危重症组GCS评分、ALB、OI明显降低(P<0.05)，SOFA评分、WBC、NEU、RDW、CRP、CAR、PCT、NLR、Lac水平明显升高(P<0.05)。与危重症组比较，极危重症组GCS评分、ALB、OI明显降低(P<0.05)，SOFA评分、WBC、NEU、RDW、CRP、CAR、PCT、NLR、Lac水平明显升高(P<0.05)(表1)。
2.2 CAR与重症肺炎患者病情严重程度的关系
Pearson相关分析结果显示，CAR与APACHE Ⅱ评分呈明显正相关(r=0.716，P<0.05)。
2.3 重症肺炎患者病情严重程度的影响因素
将表1中有差异的指标作为自变量，将肺炎病情严重程度(危重症/极危重症=1，非危重症=0)作为因变量进行多因素logistic回归分析，赋值如表2所示(由于CAR为CRP与ALB的比值，故未将CRP和ALB纳入多因素分析)。结果显示，CAR、NLR、Lac水平高是重症肺炎患者病情严重的独立危险因素(P<0.05，表3)。
2.4 不同预后患者的临床资料比较
死亡组的APACHE Ⅱ评分、SOFA评分、WBC、NEU、RDW、CRP、CAR、PCT、NLR、Lac水平明显高于存活组，GCS评分、ALB、OI明显低于存活组，差异均有统计学意义(P<0.05，表4)。
2.5 CAR与重症肺炎患者28 d死亡的独立相关性
将表4中P<0.05的变量纳入logistic回归模型，并逐步排除存在共线性的混杂因素，最终校正年龄、性别、BMI、高血压、糖尿病、APACHE Ⅱ评分、GCS评分、SOFA评分、WBC、NEU、RDW、NLR、FIB、PCT、Lac、CRP等协变量后(模型5)，结果显示，CAR与患者死亡风险仍存在独立相关性(OR=1.63，95%CI 1.07~1.95，P<0.001)。将CAR转化为二分类变量后，与较低的CAR比较，较高的CAR与患者死亡风险存在独立相关性(OR=1.60，95%CI 1.18~1.84，P<0.001)。与CAR最低的五分位数(Q1)组比较，随着CAR逐渐增高(Q2－Q5)，趋势性检验显示差异有统计学意义(P趋势<0.001)(表5)。
2.6 CAR与重症肺炎患者28 d死亡风险相关性的亚组分析
对筛选的混杂因素进行亚组分析发现，在不同的APACHE Ⅱ评分、GCS评分、SOFA评分、WBC、NEU、RDW、PCT、NLR、Lac间，CAR与重症肺炎患者28 d死亡风险的相关性稳定存在，且与NLR、Lac亚组间存在交互作用(P<0.05，表6)。
2.7 CAR与重症肺炎患者28 d死亡的剂量-反应关系
RCS模型分析结果显示，CAR与不同性别重症肺炎患者28 d死亡风险均不存在非线性剂量-反应关系(图1)。
2.8 CAR及相关因素对重症肺炎患者28 d死亡的预测价值
ROC曲线分析显示，CAR、Lac、NLR对重症肺炎患者28 d死亡的预测价值良好，三者联合的预测效能明显高于单一指标(表7)。
3 讨论
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炎症反应作为机体对外部刺激或内部损伤的一种防御性反应，在重症肺炎的发展过程中扮演着至关重要的角色。从初始的局部炎症反应到随后的全身炎症反应综合征，乃至最终的多器官功能障碍综合征，炎症反应贯穿于重症肺炎的整个病理生理过程[17-19]。这一过程不仅涉及大量炎性细胞的活化和炎性介质的释放，还伴随着一系列复杂的生理变化，如微循环障碍、代谢异常及免疫功能紊乱等，共同构成了重症肺炎复杂多变的临床表现和预后特征。
近年来，随着对炎症反应认识的深入，研究者们不断探索能够有效反映全身炎症状态的新型标志物，以期更准确地评估疾病的进展和预后。其中CAR作为一种新兴的炎症指标，逐渐展现出其在多种疾病(如胃癌、急性冠脉综合征及呼吸衰竭等)预后评估中的潜在应用价值[20-22]。CAR结合了CRP和ALB两个关键指标的信息[23-24]，前者作为急性时相反应蛋白，在感染、炎症及组织损伤时迅速升高，是反映机体炎症活动强度的敏感指标[25]；后者则是维持血浆胶体渗透压、运输物质及参与免疫反应的重要血浆蛋白，其水平下降往往预示着营养状况恶化及免疫功能受损[26]。因此，CAR通过反映CRP与ALB之间的动态平衡，为评估全身炎症状态提供了新的视角。在发生重症肺炎时，CRP水平升高已被广泛认为是疾病活动和感染严重程度的标志，其动态变化对于指导抗感染治疗及预测疾病进展具有重要意义。
与此同时，有研究指出，重症肺炎患者常伴有低白蛋白血症，这不仅反映了机体营养状况的恶化，也可能通过影响免疫功能、抗氧化能力及药物代谢等多个方面进一步加重病情并影响预后[27]。因此，将CRP与ALB结合起来考虑，通过计算CAR，可更全面地评估重症肺炎患者的炎症负荷、营养状态及免疫功能，从而更准确地预测病情发展和短期预后。本研究通过对比分析不同病情严重程度重症肺炎患者的CAR水平，发现极危重症组及危重症组患者的CAR明显高于非危重症组，证实CAR与重症肺炎病情严重程度呈正相关关系。这一发现不仅支持了先前关于CAR作为炎症标志物在多种疾病预后评估中的价值的假设，还进一步拓展了其在重症肺炎领域的应用前景。
本研究还通过比较死亡组与存活组患者的CRP、ALB及CAR水平，揭示了CAR与重症肺炎患者28 d死亡风险的独立相关性，即使在排除了其他潜在的混杂因素后，这种相关性依然稳定存在。这一结果强调了CAR作为预后评估指标的可靠性及有效性。本研究进一步通过对不同亚组的深入分析发现，无论APACHE Ⅱ评分、GCS评分、SOFA评分、WBC、NEU、RDW、PCT、Lac如何变化，CAR与重症肺炎患者28 d死亡风险的相关性均保持稳定，且各亚组间未观察到交互作用，进一步证实了CAR作为预后评估指标的广泛适用性和稳定性。此外，利用RCS模型分析CAR与重症肺炎患者28 d死亡风险的剂量-反应关系，均未观察到在不同性别中的非线性关系，进一步强化了CAR作为预后预测工具的准确性和可靠性。
综上所述，本研究发现，高CAR是重症肺炎患者病情严重程度的独立危险因素，且随着CAR的升高，患者的死亡风险增高，因此，CAR可作为评估病情严重程度的新途径，有助于预测患者的死亡风险。然而，本研究为回顾性研究，且样本量较小，存在一定的局限性。未来仍需开展多中心、大样本的前瞻性研究，以进一步明确CAR与重症肺炎病情严重程度的关系。
基金
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  • 阜阳市自筹经费科技计划项目(FK202081003)
文献
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doi: 10.11855/j.issn.0577-7402.0345.2024.1215
  • 接收时间：2024-01-18
  • 首发时间：2025-11-10
  • 出版时间：2025-03-28
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  • 收稿日期：2024-01-18
  • 录用日期：2024-05-11
基金
Fuyang City Self Foundation Science and Technology Plan Project(FK202081003)
阜阳市自筹经费科技计划项目(FK202081003)
作者信息
    阜阳市人民医院重症医学科，安徽阜阳 236000

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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