重症急性胰腺炎患者并发急性肾损伤的影响因素分析
Analysis of risk factors of acute kidney injury in patients with severe acute pancreatitis
林珊羽 1王飞龙 2朱建华3
作者信息
- 1. 315000 宁波,宁波大学医学部
- 2. 上海 200120,上海东方医院
- 3. 315000 宁波,宁波大学附属第一医院重症医学科
- 折叠
摘要
目的 探讨重症急性胰腺炎(SAP)患者并发急性肾损伤(AKI)的影响因素.方法 采用回顾性研究的方法,收集 66 例SAP患者的临床资料,根据是否并发AKI分为AKI组和非AKI组,分别采用Logistic回归和受试者操作特征(ROC)曲线分析SAP患者并发AKI的危险因素.结果 SAP合并AKI患者的总体年龄和急性生理学和慢性健康状况评价(APACHEⅡ)评分高于未合并者,但糖尿病多见于未合并者(P<0.05).与非AKI组相比,AKI组患者入院时的CRP、全身炎症反应指数(SIRI)、血清肌酐、CRP/白蛋白比值、D-二聚体升高,但三酰甘油-葡萄糖(TyG)指数、白蛋白、总胆固醇、HDL-C、血钙水平下降(P<0.05).逐步回归分析结果显示,APACHEⅡ评分升高、SIRI升高、血小板/淋巴细胞比值(PLR)升高、全身免疫炎症指数(SII)降低、血钙水平下降是SAP患者并发AKI的独立危险因素(P<0.05).ROC曲线结果显示,除血清肌酐外,APACHEⅡ评分、SIRI指数、血钙水平对SAP患者并发AKI有一定的诊断价值,其中APACHEⅡ评分的AUC为 0.880(95%CI 0.787～0.974,截断值 11.50 分),SIRI指数的AUC为 0.662(95%CI 0.521～0.804,截断值 10.89),血钙水平的AUC为 0.754(95%CI 0.627～0.881,截断值2.07 mmol/L),P均<0.05;当上述三种指标联合血清肌酐时可进一步提高对于SAP患者并发AKI 的诊断效能,其中血清肌酐+血钙的AUC最大,达 0.969(95%CI 0.929～1.000,P<0.05).结论 APACHEⅡ评分、SIRI指数、PLR指数、SII指数、血钙水平是SAP并发AKI的影响因素,APACHEⅡ评分、SIRI指数和血钙水平对SAP患者并发AKI具有诊断价值,三者联合血清肌酐可提高对AKI的诊断效能,为临床识别SAP患者并发AKI提供新的手段.
Abstract
Objective To investigate the risk factors of acute kidney injury (AKI) in patients with severe acute pancreatitis (SAP). Methods Clinical data of 66 patients with SAP were collected in this retrospective study. All patients were divided into the AKI and non-AKI groups according to whether they were complicated with AKI. The risk factors of AKI in patients with SAP were identified by using Logistic regression analysis and receiver operating characteristic (ROC) curve. Results The overall age and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱscore of SAP patients complicated with AKI were higher than those without AKI, but diabetes mellitus was more common in non-AKI patients (all P < 0.05). Patients in the AKI group had higher levels of hypersensitive C-reactive protein (CRP), systemic inflammatory response index (SIRI), creatinine (Scr), CRP/Albumin (Alb) index and D-dimer (DDI) upon admission, whereas had lower fasting triglyceride and glucose simple index (TyG), Alb, total cholesterol, high density lipoprotein cholesterol (HDL-C) and blood calcium levels compared with their counterparts without AKI, and the differences were statistically significant (all P < 0.05). Stepwise regression analysis showed that increased APACHE Ⅱscore, increased SIRI index, increased PLR index, decreased SII index and decreased blood calcium were the independent risk factors for SAP patients complicated with AKI (all P < 0.05). ROC curve results showed that in addition to Scr, APACHEⅡ score, SIRI index and blood calcium had certain diagnostic value in SAP patients complicated with AKI, among which the area under the ROC curve (AUC) of APACHE Ⅱ score was 0.880 (95％ CI 0.787-0.974, optimal cutoff value 11.50), 0.662 (95％ CI 0.521-0.804, optimal cutoff value 10.89) for SIRI index, and 0.754 (95％ CI 0.627-0.881, optimal cutoff value 2.07 mmol/L) for blood calcium level (all P < 0.05). The combination of the above three indexes with Scr could further improve the diagnostic value for AKI in SAP patients, among which the AUC of Scr + blood calcium was the largest, reaching 0.969 (95％ CI 0.929-1.000, P < 0.05). Conclusions APACHEⅡ score, SIRI index, PLR index, SII index and blood calcium level are the independent risk factors of AKI in SAP patients. APACHEⅡ score, SIRI index and blood calcium have diagnostic value in SAP patients complicated with AKI. The combination of these three indexes with Scr can significantly improve the diagnostic efficiency for AKI, providing a novel diagnostic approach for AKI in SAP patients.
关键词
重症急性胰腺炎/急性肾损伤/炎症/血钙/血清肌酐/急性生理学和慢性健康状况评价/全身炎症反应指数Key words
Severe acute pancreatitis/Acute kidney injury/Inflammation/Blood calcium/Serum creatinine/Acute physiology and chronic health evaluation/systemic inflammatory response index引用本文复制引用
基金项目
浙江省医药卫生科技计划(2022KY1117)
浙江省医药卫生科技计划(2023KY255)
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据