新医学2024，Vol.55Issue(4)：303-310,8.DOI:10.3969/j.issn.0253-9802.2024.04.012
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
摘要
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
林珊羽,王飞龙,朱建华..重症急性胰腺炎患者并发急性肾损伤的影响因素分析[J].新医学,2024,55(4):303-310,8.基金项目
浙江省医药卫生科技计划项目(2022KY1117,2023KY255) （2022KY1117,2023KY255）
