重症监护病房急性肾损伤患者首次24 h动脉氧分压与死亡率相关：基于MIMIC-IV数据库

doi:10.12122/j.issn.1673-4254.2025.05.19

摘要/Abstract

摘要：

目的基于MIMIC-IV数据库的回顾性临床数据，旨在评估急性肾损伤（AKI）患者在ICU入院后首个24 h平均动脉氧分压（PaO₂）与死亡率的关系，并确定适宜的PaO₂阈值以指导氧疗策略。方法根据入院后24 h内的平均动脉氧分压（PaO₂），通过受试者工作特征（ROC）曲线分析及约登指数最大化原则确定最佳PaO₂截断值（137.029 mmHg），将患者分为高氧组（PaO₂≥137 Hg）和低氧组（PaO₂<137 Hg）。采用多变量逻辑回归分析和倾向评分匹配方法评估氧水平与住院死亡率之间的关系。结果在18 335名患者中，46.7%的患者属于高氧组，且整体死亡率为16.9%。高氧状态与较低的院内死亡率（OR=0.78）和90 d死亡率（OR=0.77）相关，尤其在AKI 1期患者中。研究还发现PaO₂与死亡率之间存在非线性关系（P<0.001）。Kaplan-Meier生存曲线显示，高氧组的90 d生存率提高（P<0.001），且高氧组的机械通气时间、血管加压药使用时间及住院/ICU时长均较短。结论在AKI患者中维持PaO₂≥137 Hg可改善临床预后，强调了ICU治疗中目标导向氧供的重要性。

关键词: 重症监护病房, MIMIC-IV, 急性肾损伤, 动脉氧分压, 死亡率, 倾向评分

Abstract:

Objective To evaluate the correlation of mean arterial oxygen tension (PaO₂) during the first 24 h following intensive care unit (ICU) admission with mortality in critically ill patients with acute kidney injury (AKI) and determine the optimal PaO₂ threshold for devising oxygen therapy strategies for these patients. Methods We collected the clinical data of ICU patients with AKI from the MIMIC-IV database. Based on the optimal first 24-h PaO₂ threshold determined by receiver operating characteristic (ROC) curve analysis and the Youden index maximization principle, we classified the patients into hyperoxia group (with PaO₂ ≥137.029 mmHg) and hypoxemia group (PaO₂<137.029 mm Hg). Multivariable logistic regression and propensity score matching were used to evaluate the correlation of first 24-h PaO₂ levels with in-hospital mortality of the patients. Results Among the 18 335 patients, 46.7% were in the hyperoxia group, who had an overall mortality rate of 16.9%. The optimal PaO₂ threshold (137.029 mm Hg) had a sensitivity of 78.3%, a specificity of 63.7%, and an AUC of 0.76 (95% CI: 0.74=0.78). Hyperoxia within the first 24 h after ICU admission was associated with a significantly lower in-hospital mortality (OR=0.78) and 90-day mortality (OR=0.77), particularly in stage 1 AKI patients. A non-linear relationship was identified between PaO₂ and mortality of the patients (P<0.001). Kaplan-Meier survival curves indicated a significantly increased 90-day survival rate in the patients in hyperoxia group (P<0.001), who also had shorter durations of mechanical ventilation, less vasopressor use, and shorter lengths of hospital/ICU stay. Conclusion Maintenance of a PaO₂ level ≥137.029 mmHg within 24 h after ICU admission may improve clinical outcomes of critically ill AKI patients, which underscores the importance of targeted oxygen delivery in ICU care.

Key words: intensive care unit, MIMIC-IV database, acute kidney injury, arterial oxygen partial pressure, mortality, propensity score

王子皓, 陶丽丽, 邹碧清, 安胜利. 重症监护病房急性肾损伤患者首次24 h动脉氧分压与死亡率相关：基于MIMIC-IV数据库[J]. 南方医科大学学报, 2025, 45(5): 1056-1062.

Zihao WANG, Lili TAO, Biqing ZOU, Shengli AN. First 24-hour arterial oxygen partial pressure is correlated with mortality in ICU patients with acute kidney injury: an analysis based on MIMIC-IV database[J]. Journal of Southern Medical University, 2025, 45(5): 1056-1062.

图/表 5

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Outcome	Total	PaO₂≥137.029 mm Hg	PaO₂<137.029 mm Hg	P
Before PSM
Patients (n)	18 335	8565	9770
In-hospital mortality [n (%)]	3099 (16.9)	840 (9.8)	2259 (23.1)	<0.001
90-day mortality [n (%)]	3342 (18.2)	912 (10.6)	2430 (24.9)	<0.001
CRRT [n (%)]	312 (1.7)	86 (1.0)	226 (2.3)	<0.001
RRT [n (%)]	1068 (5.8)	282 (3.3)	786 (8.0)	<0.001
Duration of ventilator [h, median (IQR)]	41.0 (17.0-103.7)	16.0 (7.8-40.0)	23.0 (10.6-70.0)	<0.001
Duration of vasopressor [h, median (IQR)]	29.4 (11.3-67.4)	14.1 (3.7-35.0)	19.4 (6.0-48.9)	<0.001
LOS Hospital (day)	9.0 (5.0-16.0)	8.0 (5.0-13.0)	8.0 (5.0-15.0)	<0.001
LOS ICU (day)	3.2 (1.9-6.6)	2.3 (1.3-4.6)	2.9 (1.6-5.6)	<0.001
After PSM
Patients (n)	8838	4419	4419
In-hospital mortality [n (%)]	1494 (16.9)	672 (15.2)	822 (18.6)	<0.001
90-day mortality [n (%)]	1616 (18.3)	724 (16.4)	892 (20.2)	<0.001
CRRT [n (%)]	142 (1.6)	77 (1.7)	65 (1.5)	0.310
RRT [n (%)]	502 (5.7)	234 (5.3)	268 (6.1)	0.118
Duration of ventilator [h, median (IQR)]	33.0 (14.8-89.3)	24.0 (11.0-68.5)	28.0 (12.7-79.0)	<0.001
Duration of vasopressor [h, median (IQR)]	23.8 (8.6-57.4)	20.5 (6.3-53.0)	22.2 (7.4-55.4)	0.068
LOS Hospital	9.0 (6.0-16.0)	9.0 (5.0-15.0)	9.0 (5.0-16.0)	0.008
LOS ICU	3.3 (1.9-6.8)	3.0 (1.7-6.0)	3.1 (1.8-6.4)	<0.001

Outcome	Total	PaO₂≥137.029 mm Hg	PaO₂<137.029 mm Hg	P
Before PSM
Patients (n)	18 335	8565	9770
In-hospital mortality [n (%)]	3099 (16.9)	840 (9.8)	2259 (23.1)	<0.001
90-day mortality [n (%)]	3342 (18.2)	912 (10.6)	2430 (24.9)	<0.001
CRRT [n (%)]	312 (1.7)	86 (1.0)	226 (2.3)	<0.001
RRT [n (%)]	1068 (5.8)	282 (3.3)	786 (8.0)	<0.001
Duration of ventilator [h, median (IQR)]	41.0 (17.0-103.7)	16.0 (7.8-40.0)	23.0 (10.6-70.0)	<0.001
Duration of vasopressor [h, median (IQR)]	29.4 (11.3-67.4)	14.1 (3.7-35.0)	19.4 (6.0-48.9)	<0.001
LOS Hospital (day)	9.0 (5.0-16.0)	8.0 (5.0-13.0)	8.0 (5.0-15.0)	<0.001
LOS ICU (day)	3.2 (1.9-6.6)	2.3 (1.3-4.6)	2.9 (1.6-5.6)	<0.001
After PSM
Patients (n)	8838	4419	4419
In-hospital mortality [n (%)]	1494 (16.9)	672 (15.2)	822 (18.6)	<0.001
90-day mortality [n (%)]	1616 (18.3)	724 (16.4)	892 (20.2)	<0.001
CRRT [n (%)]	142 (1.6)	77 (1.7)	65 (1.5)	0.310
RRT [n (%)]	502 (5.7)	234 (5.3)	268 (6.1)	0.118
Duration of ventilator [h, median (IQR)]	33.0 (14.8-89.3)	24.0 (11.0-68.5)	28.0 (12.7-79.0)	<0.001
Duration of vasopressor [h, median (IQR)]	23.8 (8.6-57.4)	20.5 (6.3-53.0)	22.2 (7.4-55.4)	0.068
LOS Hospital	9.0 (6.0-16.0)	9.0 (5.0-15.0)	9.0 (5.0-16.0)	0.008
LOS ICU	3.3 (1.9-6.8)	3.0 (1.7-6.0)	3.1 (1.8-6.4)	<0.001

Groups	N	Outcomes	OR	95% CI	P
Sensitivity analysis A	7282	In-hospital	0.84	0.75-0.95	0.006
		90-day	0.85	0.76-0.96	0.007
Sensitivity analysis B	7475	In-hospital	0.84	0.74-0.95	0.004
		90-day	0.84	0.74-0.94	0.003

Groups	N	Outcomes	OR	95% CI	P
Sensitivity analysis A	7282	In-hospital	0.84	0.75-0.95	0.006
		90-day	0.85	0.76-0.96	0.007
Sensitivity analysis B	7475	In-hospital	0.84	0.74-0.95	0.004
		90-day	0.84	0.74-0.94	0.003

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