DIC评分系统联合血清胱抑素C对重症肺炎患者急性肾损伤的临床价值

Clinical value of DIC scoring system combined with serum cystatin C in the diagnosis of acute kidney injury in patients with severe pneumonia

目的探讨弥散性血管内凝血(disseminated intravascular coagulation,DIC)国际血栓和止血学会(International Society of Thrombosis and Hemostasis criteria,ISTH)评分系统联合血清胱抑素C对重症肺炎患者急性肾损伤的临床价值。方法回顾性分析2014年10月至2018年10月四川大学华西广安医院收治的153例重症肺炎患者的病例资料,根据是否合并急性肾损伤将患者分为急性肾损伤组(n=51)与非急性肾损伤组(n=102)。采用酶联免疫吸附法检测患者血清胱抑素C水平,比较两组患者的ISTH评分及血清胱抑素C水平,并通过受试者工作特征曲线(receiver operator characteristic curve,ROC)和曲线下面积评价ISTH联合血清胱抑素C、ISTH评分以及C反应蛋白对重症肺炎患者急性肾损伤的评估价值,用logistic回归分析重症肺炎患者急性肾损伤预后因素。结果急性肾损伤组的住院病死率、住院时间、序贯器官衰竭评分、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation scoring systemⅡ,APACHEⅡ)评分、平均动脉压、休克发生率以及白细胞计数、降钙素原水平、体温等感染炎性指标均明显高于非急性肾损伤组(P<0.05),ISTH评分、血清胱抑素C水平明显高于非急性肾损伤组(P<0.05)。在重症肺炎急性肺损伤患者中ISTH评分联合血清胱抑素C的ROC曲线下面积高于ISTH评分及血清胱抑素C的ROC曲线下面积,且敏感值、约登指数也较高。Logistic回归分析显示,年龄>60岁(OR=1.21,95%CI:0.90~1.61)、ISTH评分>3.6分(OR=3.40,95%CI:2.24~5.18)、血清胱抑素C>3.2mg/L(OR=3.76,95%CI:2.27~6.24)为重症肺炎急性肾损伤患者的预后危险因素。结论 ISTH评分联合血清胱抑素C对重症肺炎患者的急性肾损伤具有重要的临床价值。

Objective To investigate the clinical value of disseminated intravascular coagulation(DIC)scoring system(International Society on Thrombosis and Hemostasis,ISTH)combined with serum cystatin C in the diagnosis of acute kidney injury in patients with severe pneumonia.Method The clinical data of 153 patients with severe pneumonia admitted to our hospital from October 2014 to October 2018 were retrospectively analyzed.According to the diagnostic criteria of acute kidney injury,the patients were divided into acute kidney injury group(n=51)and non-acute kidney injury group(n=102).Serum levels of statin C were measured by ELISA.ISTH score and serum cystatin C were compared between the two groups.The value of ISTH combined with serum cystatin C,ISTH score and CRP in the diagnosis of acute kidney injury in severe pneumonia patients was evaluated by ROC and AUC.The prognostic factors of acute renal injury in patients with severe pneumonia were determined by logistic regression.Result The mortality,length of stay,Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ score,MAP,shock incidence,WBC(white blood cell count),PCT(procalcitonin),T(body temperature)and other infectious inflammatory indicators in acute renal injury group were significantly higher than those in non-acute renal injury group(P<0.05).The ISTH score and serum cystatin C level in acute renal injury group were significantly higher than those in non-acute renal injury group(P<0.05).AUCs of ISTH score and serum cystatin C had no significant difference(P>0.05),while the AUC of serum cystatin C combined with ISTH had statistic difference with the ACUs of ISTH score and serum cystatin C(P<0.05),moreover,the sensitivity and Youden index of the combine detection were higher than those of the single detection.Logistic regression analysis showed that age>60 years(OR=1.21,95%CI:0.90-1.61),ISTH score>3.6(OR=3.40,95%CI:2.24-5.18),serum cystatin C>3.2 mg/L(OR=3.76,95%CI:2.27-6.24)were risk factors for the prognosis of severe pneumonia patients with acute renal injury.Conclusion The combined detection of ISTH score and serum cystatin C has important clinical value in evaluating acute kidney injury in patients with severe pneumonia.