通讯作者: 徐帅, wzszyyjzkxs@163.com

DOI：10.12201/bmr.202610.00020

Dynamic Serum Albumin Changes and Incremental Prognostic Value in Sepsis-Associated Acute Lung Injury: A Longitudinal-Survival Analysis Using the MIMIC-IV Database

• 摘要：目的 本研究旨在评估脓毒症相关急性肺损伤（ALI）患者中，早期血清白蛋白的动态演变（涵盖入院时基线值及短期变化速率）对28天预后的影响，并进一步验证该动态指标在传统风险因素之外是否具备独立的预后增益效能。方法 基于MIMIC-IV数据库，回顾性纳入3071例脓毒症合并ALI患者。利用入ICU后0-72小时内的所有重复白蛋白测量数据，构建纵向-生存联合模型，估计白蛋白的当前水平和变化斜率与28天全因死亡风险的关联。采用嵌套模型策略评估增量预测价值。次要结局包括90天死亡率和28天无呼吸机天数。动态白蛋白分析主要限于0～72 h 内至少完成2次白蛋白测量的患者。结果 本研究发现，当前白蛋白每降低0.5g/dL与28天死亡风险增加独立相关（HR=1.289，95%CI：1.196~1.390，P<0.001）；与此同时在至少2次白蛋白测量的患者中，白蛋白下降斜率亦显著增加死亡风险（HR=1.991，95%CI：1.048~3.781，P=0.035）。其中液体平衡和氧合状态对白蛋白的预后效应具有显著修饰作用（交互P<0.05）。在临床基准模型（AUROC=0.710）的基础上，加入静态白蛋白后提升至0.716；加入动态白蛋白后进一步提升至0.727。校准斜率良好（0.958），而含动态白蛋白的模型在临床合理阈值概率范围内具有正向净获益。以上结果得到了敏感性分析的进一步验证。结论 早期动态白蛋白（尤其是当前水平和下降速度）与脓毒症合并ALI患者短期死亡风险独立相关，并在传统临床指标基础上提供更多的增量预测信息。动态白蛋白可作为现有风险分层体系的补充辅助指标，其临床决策价值仍需前瞻性、多中心研究进一步验证。

  关键词： 脓毒症; 急性肺损伤; 白蛋白; MIMIC-IV 数据库; 动态预后标志物

   

  Abstract: Objective This study aims to evaluate the impact of early dynamic changes in serum albumin levels—encompassing baseline values upon admission and short-term rate of change—on 28-day outcomes in patients with sepsis-associated acute lung injury (ALI), and further assess whether this dynamic marker provides independent prognostic value beyond traditional risk factors.Methods Based on the MIMIC-IV database, 3,071 patients with sepsis complicated by acute lung injury (ALI) were retrospectively included. Using all repeated albumin measurements within 0–72 hours after ICU admission, a longitudinal-survival joint model was constructed to estimate the association between current albumin levels and their rate of change with 28-day all-cause mortality risk. A nested model strategy was employed to assess incremental predictive value. Secondary outcomes included 90-day mortality and ventilator-free days at 28 days. Dynamic albumin analysis is mainly applicable to patients who have had at least two albumin measurements within a period of 0 to 72 hours.Results This study found that each 0.5 g/dL decrease in current albumin level was independently associated with an increased risk of 28-day mortality (hazard ratio HR = 1.289, 95% confidence interval CI: 1.196–1.390, P < 0.001). Meanwhile, among patients with at least two albumin measurements, a steeper decline in albumin levels also significantly increased the risk of death (HR=1.991, 95% CI: 1.048–3.781, P = 0.035). Fluid balance and oxygenation status significantly modified the prognostic effect of albumin (interaction P < 0.05). Adding static albumin to the clinical baseline model improved the AUROC from 0.710 to 0.716; further inclusion of dynamic albumin increased it to 0.727. The calibration slope was favorable (0.958), and the model incorporating dynamic albumin demonstrated positive net benefit within clinically reasonable threshold probability ranges. These findings were further confirmed by sensitivity analyses.Conclusions Early dynamic albumin (especially the current level and the rate of decline) is independently associated with the short-term mortality risk of patients with sepsis complicated by ALI, and provides additional incremental predictive information beyond traditional clinical indicators. Dynamic albumin can serve as an auxiliary indicator to complement the existing risk stratification system. The clinical value of this approach still requires further verification through prospective and multi-center studies.

  Key words: Sepsis；Acute Lung Injury；Serum Albumin；MIMIC-IV Database；Dynamic Prognostic Marker; ; ; ; 

  提交时间：2026-10-11

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
• html

• 图表

• 顾洁, 邢清敏, 肖涛, 李明. 乳酸/白蛋白比值联合APACHE II评分在脓毒症患者预后评估中的价值. 2026. doi: 10.12201/bmr.202603.00104

  陈薪竹, 刘承鑫, 郑爱华★. 基于“肺肠同治”理论探析生血通便颗粒治疗脓毒症急性肺损伤经验*. 2025. doi: 10.12201/bmr.202509.00041

  田欣, 陈红军, 谢健. 基于Transformer与可解释人工智能的老年脓毒症预后预测模型：一项多中心研究. 2026. doi: 10.12201/bmr.202605.00087

  周思岑. 微小RNA在脓毒症相关急性肾损伤中的作用. 2024. doi: 10.12201/bmr.202410.00011

  钱新阳, 王育民. pSOFA评分联合AGI分级评估脓毒症患儿预后的价值. 2024. doi: 10.12201/bmr.202411.00002

  丁荔. 镁离子水平与脓毒症预后的研究现状. 2025. doi: 10.12201/bmr.202509.00008

  邵宏华, 朱亮, 李莎, 陈巧巧. 丙氨酰谷氨酰胺联合奥曲肽治疗急性胰腺炎相关性肺损伤患者的疗效及对血清TLR4、MMP-9水平的影响. 2024. doi: 10.12201/bmr.202412.00062

  颜林朗, 樊恒. 脓毒症急性肾损伤中脑啡肽原119-159的应用价值. 2024. doi: 10.12201/bmr.202408.00070

  热米兰木·尼扎木丁, 康绍涛, 热依拉·吐尔洪, 拜合提尼沙·吐尔地. 脓毒症患者血红蛋白动态下降的分型评估与临床干预进展. 2026. doi: 10.12201/bmr.202609.00002

  张昊天, 刘雪, 李淑菊. 急性肾损伤生物标志物的相关研究进展. 2025. doi: 10.12201/bmr.202508.00028

• 序号	提交日期	编号	操作
  1	2026-07-29	10.12201/bmr.202610.00020V1	下载

• 公开评论  匿名评论  仅发给作者 提交评论