摘要目的:探讨早期血清乳酸、白蛋白、乳酸/白蛋白比值（L/A）对脓毒症成人患者28 d预后的预测价值。方法:采用回顾性队列研究，纳入2020年1月至12月新疆医科大学第一附属医院收治的脓毒症成人患者，记录其基本资料，包括性别、年龄、合并症、入院24 h内乳酸、白蛋白、L/A、白细胞介素-6（IL-6）、降钙素原（PCT）、C-反应蛋白（CRP）及28 d预后情况。绘制受试者工作特征曲线（ROC曲线），分析乳酸、白蛋白、L/A对脓毒症患者28 d死亡的预测价值，并根据最佳截断值对患者进行亚组分析，绘制Kaplan-Meier生存曲线，分析脓毒症患者28 d累积生存情况。结果:共纳入274例脓毒症患者，28 d死亡122例，28 d病死率为44.53%。与存活组比较，死亡组年龄、肺部感染比例、休克比例、乳酸、L/A和IL-6明显升高，白蛋白明显下降〔年龄（岁）：65（51，79）比57（48，73），肺部感染：75.4%比53.3%，休克：37.7%比15.1%，乳酸（mmol/L）：4.76（2.95，9.23）比2.21（1.44，3.19），L/A：0.18（0.10，0.35）比0.08（0.05，0.11），IL-6（ng/L）：337.00（97.73，2 318.50）比55.88（25.26，150.65），白蛋白（g/L）：27.68（21.02，33.03）比29.62（25.25，34.23），均 P<0.05〕。乳酸、白蛋白和L/A预测脓毒症患者28 d死亡的ROC曲线下面积（AUC）和95%可信区间（95% CI）分别为0.794（95% CI为0.741~0.840）、0.589（95% CI为0.528~0.647）、0.807（95% CI为0.755~0.852）；乳酸最佳截断值为4.07 mmol/L时，敏感度为57.38%，特异度为92.76%；白蛋白最佳截断值为22.28 g/L时，敏感度为31.15%，特异度为92.76%；L/A最佳截断值为0.16时，敏感度为54.92%，特异度为95.39%。亚组分析显示，L/A>0.16组脓毒症患者28 d病死率显著高于L/A≤0.16组〔90.5%（67/74）比27.5%（55/200）， P<0.001〕；白蛋白≤22.28 g/L组脓毒症患者28 d病死率显著高于白蛋白>22.28 g/L组〔77.6%（38/49）比37.3%（84/225）， P<0.001〕；乳酸>4.07 mmol/L组脓毒症患者28 d病死率显著高于乳酸≤4.07 mmol/L组〔86.4%（70/81）比26.9%（52/193）， P<0.001〕，三者与Kaplan-Meier生存曲线分析结果吻合。 结论:早期血清乳酸、白蛋白和L/A均对脓毒症患者28 d预后有预测价值，且L/A的预测作用比乳酸和白蛋白更好。

abstractsObjective:To investigate the prognostic value of early serum lactate, albumin, and lactate/albumin ratio (L/A) on the 28-day prognosis of adult patients with sepsis.Methods:A retrospective cohort study was conducted among adult patients with sepsis admitted to the First Affiliated Hospital of Xinjiang Medical University from January to December in 2020. Gender, age, comorbidities, lactate within 24 hours of admission, albumin, L/A, interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and 28-day prognosis were recorded. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of lactate, albumin and L/A for 28-day mortality in patients with sepsis. Subgroup analysis of patients was performed according to the best cut-off value, Kaplan-Meier survival curves were drawn, and the 28-day cumulative survival of patients with sepsis was analyzed.Results:A total of 274 patients with sepsis were included, and 122 patients died at 28 days, with a 28-day mortality of 44.53%. Compared with the survival group, the age, the proportion of pulmonary infection, the proportion of shock, lactate, L/A and IL-6 in the death group were significantly increased, and albumin was significantly decreased [age (years): 65 (51, 79) vs. 57 (48, 73), pulmonary infection: 75.4% vs. 53.3%, shock: 37.7% vs. 15.1%, lactate (mmol/L): 4.76 (2.95, 9.23) vs. 2.21 (1.44, 3.19), L/A: 0.18 (0.10, 0.35) vs. 0.08 (0.05, 0.11), IL-6 (ng/L): 337.00 (97.73, 2 318.50) vs. 55.88 (25.26, 150.65), albumin (g/L): 27.68 (21.02, 33.03) vs. 29.62 (25.25, 34.23), all P < 0.05]. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) of lactate, albumin, and L/A were 0.794 (95% CI was 0.741-0.840), 0.589 (95% CI was 0.528-0.647), 0.807 (95% CI was 0.755-0.852) for predicting 28-day mortality in sepsis patients. The optimal diagnostic cut-off value of lactate was 4.07 mmol/L, the sensitivity was 57.38%, the specificity was 92.76%. The optimal diagnostic cut-off value of albumin was 22.28 g/L, the sensitivity was 31.15%, the specificity was 92.76%. The optimal diagnostic cut-off of L/A was 0.16, the sensitivity was 54.92%, and the specificity was 95.39%. Subgroup analysis showed that the 28-day mortality of sepsis patients in the L/A > 0.16 group was significantly higher than that in the L/A ≤ 0.16 group [90.5% (67/74) vs. 27.5% (55/200), P < 0.001]. The 28-day mortality of sepsis patients in the albumin ≤ 22.28 g/L group was significantly higher than that in the albumin > 22.28 g/L group [77.6% (38/49) vs. 37.3% (84/225), P < 0.001]. The 28-day mortality in the group with lactate > 4.07 mmol/L was significantly higher than that in the group with lactate ≤ 4.07 mmol/L [86.4% (70/81) vs. 26.9% (52/193), P < 0.001]. The three were consistent with the analysis results of Kaplan-Meier survival curve. Conclusion:The early serum lactate, albumin, and L/A were all valuable in predicting the 28-day prognosis of patients with sepsis, and L/A was better than lactate and albumin.