血清铁与急性胰腺炎病人预后的相关性研究

Association between serum iron levels and prognosis in patients with acute pancreatitis

目的:目前较少研究关注急性胰腺炎(AP)早期病人的血清铁(SI)水平变化以及与AP预后的相关性。本研究旨在探究AP早期SI水平的变化轨迹以及SI与AP住院期间死亡率之间的相关性。方法:连续纳入自2014年1月至2020年6月在南京大学医学院附属金陵医院住院时间≥7 d的AP急性期病人650例。记录病人入院后7 d内SI检测值并将最低值作为SI代表性水平(定义为SI_(min))。明确SI_(min)预测AP住院期间死亡率的最佳截断值,依据截断值水平将病人分成两组:高SI组(HSI,470例)和低SI组(LSI,180例)。比较两组病人器官衰竭、胰腺感染坏死发生率和住院期间死亡率,并进一步分析SI水平与住院期间死亡率之间的相关性。结果:85.8%(558/650)的AP病人在入院后一周内出现持续性低铁血症。ROC分析显示,SI_(min)对住院期间死亡率的曲线下面积(AUC)为0.828(95%CI:0.763~0.892),截断值为2.4μmol/L。LSI组病人器官衰竭(P<0.01)和胰腺感染坏死(P<0.01)发生率以及住院期间死亡率(P<0.01)均显著高于HSI组。在多变量Cox回归模型中,SI水平降低是AP病人住院死亡的独立危险因素(HR=2.511,95%CI:1.044~6.039,P<0.05)。结论:本研究表明AP早期SI水平普遍下降,SI降低的AP病人住院死亡风险显著增加,SI水平可能是评估AP病人住院死亡风险的潜在生物标志物。

Objective:Few studies focus on the changes of serum iron(SI)level in patients with acute pancreatitis(AP)and the association between SI and the prognosis of AP.This study aimed to explore the trajectory of SI level in the early stage of AP and the association between SI level and in-hospital mortality.Methods:In this study,650 patients with AP in acute stage who had been hospitalized for no less than 7 days in Jinling Hospital,affiliated hospital od Medical School,Nanjing University from January 2014 to June 2020 were included.We recorded SI values on each single day within 7 days after admission and take the lowest value as the representative SI level(defined as SI_(min)).The optimal cut-off value of SI_(min)for predicting in-hospital mortality was determined,and the patients were divided into high SI group(HSI,n=470)and low SI group(LSI,n=180)according to the cut-off level.The in-hospital mortality as well as incidences of organ failure and infected pancreatic necrosis(IPN)were compared between the two groups,and the correlation between SI level and in-hospital mortality was further analyzed.Results:Up to 85.8%(558/650)of included patients developed continuous hypoferremia.ROC analysis revealed that the area under the curve(AUC)of SI_(min)for in-hospital mortality was 0.828(95%CI,0.763~0.892),with a cut-off level of 2.4μmol/L.The in-hospital mortality(P<0.01)as well as incidences of organ failure(P<0.01)and IPN(P<0.01)in LSI patients were significantly higher than those in HSI group.In the multivariable Cox regression model,the low SI level was independently associated with in-hospital mortality in AP patients(HR=2.511;95%CI:1.044~6.039,P<0.05).Conclusion:This study demonstrated a common and continuous SI deficiency state in the early stage of AP,and the risk of in-hospital death in AP patients with decreased SI level is significantly elevated.Decreased SI levels may be a promising biomarker for early triage in AP patients.