PCT、NLR、N/LPR对重症急性胰腺炎并发急性肾损伤的预测价值

Value of PCT,NLR and N/LPR in predicting acute kidney injury in patients with severe acute pancreatitis

目的探讨降钙素原(PCT)、中性粒细胞与淋巴细胞比值(NLR)以及中性粒细胞计数与淋巴细胞和血小板计数比值(N/LPR)对重症急性胰腺炎(SAP)患者并发急性肾损伤(AKI)的预测价值。方法回顾性收集120例SAP患者作为研究对象。根据患者入院7 d是否发生AKI,分为AKI组和非AKI组,比较2组患者临床基线资料和实验室指标水平,采用受试者工作特征(ROC)曲线评价PCT、NLR、N/LPR对SAP患者并发AKI的预测价值。结果与非AKI组患者相比,AKI组患者CRP、PCT、NLR、N/LPR、乳酸水平更高(P<0.05),白蛋白水平更低(P<0.05)。多因素分析显示,PCT、NLR、N/LPR是SAP并发AKI的独立危险因素(P<0.05)。ROC曲线分析显示,PCT、NLR、N/LPR、NLR+PCT、N/LPR+PCT、N/LPR+NLR、N/LPR+NLR+PCT预测SAP并发AKI的ROC曲线下面积(AUC)分别为0.750、0.773、0.882、0.842、0.884、0.910、0.925。DeLong检验显示,N/LPR预测AKI的AUC值高于NLR和PCT(P均<0.05),NLR和PCT无差异(P>0.05)。不同指标联合试验预测AKI的AUC值与单独检测N/LPR无差异(P均>0.05)。亚组分析显示,PCT≥5.5 ng/mL组SAP患者AKI发生率高于PCT<5.5 ng/mL组;NLR≥12.72组SAP患者AKI发生率高于NLR<12.72组;N/LPR≥11.11组SAP患者AKI发生率高于N/LPR<11.11组(P均<0.05)。结论N/LPR对SAP并发AKI有较好的预测价值,优于NLR和PCT,尚未发现联合检测对AKI的预测价值优于单独检测N/LPR。

Objective To evaluate the value of procalcitonin(PCT),neutrophil-to-lymphocytes ratio(NLR),neutrophil to lymphocyte and platelet ratio(N/LPR)in predicting acute kidney injury(AKI)in patients with severe acute pancreatitis(SAP).Methods A total of 120 SAP patients were retrospectively collected.According to whether AKI occurred within 7-d hospital stay,all SAP patients were divided into the AKI and non-AKI groups.Clinical baseline data and laboratory parameters were compared between two groups.The predictive value of PCT,NLR and N/LPR for AKI in SAP patients was evaluated by the receiver operating characteristic(ROC)curve.Results In the AKI group,the C-reactive protein(CRP)level,PCT level,NLR,N/LPR and lactic acid level were significantly higher(all P<0.05),whereas the albumin level was significantly lower(P<0.05)compared with those in the non-AKI group.Multivariate logistic regression analysis showed that PCT,NLR and N/LPR were the independent risk factors for SAP complicated with AKI(all P<0.05).ROC curve analysis demonstrated that the area under the ROC curve(AUC)of PCT,NLR,N/LPR,NLR+PCT,N/LPR+PCT,N/LPR+NLR and N/LPR+NLR+PCT for predicting AKI were 0.750,0.773,0.882,0.842,0.884,0.910 and 0.925,respectively.DeLong test indicated that the AUC of N/LPR for predicting AKI was significantly higher than that of NLR and PCT(both P<0.05),whereas no significant difference was observed between NLR and PCT(P>0.05).In addition,the AUC of different parameters combined for predicting AKI did not significantly differ from that of N/LPR alone(all P>0.05).Subgroup analysis revealed that the incidence of AKI in SAP patients with PCT of≥5.5 ng/mL was significantly higher than that in their counterparts with PCT of<5.5 ng/mL.The incidence of AKI in SAP patients with NLR of≥12.72 was significantly higher compared with that in their counterparts with NLR of<12.72.The incidence of AKI in SAP patients with N/LPR of≥11.11 was significantly higher than that in their counterparts with N/LPR of<11.11(all P<0.05).Conclusions Compared with NLR and PCT,N/LPR yields higher predictive value for AKI in SAP patients.It has not been found that the predictive value of different parameters combined for AKI is better than that of N/LPR alone.