入院MPV/PLT、NPAR对重症急性胰腺炎患者并发急性肾损伤的预测价值

Predictive Value of Admission MPV/PLT and NPAR in Patients with Severe Acute Pancreatitis Complicated with Acute Kidney Injury

目的:探讨入院平均血小板体积与血小板计数比值(MPV/PLT)、中性粒细胞百分率与白蛋白比值(NPAR)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:选取2019年1月~2022年12月首都医科大学附属北京世纪坛医院重症医学科收治的117例SAP患者,根据是否并发AKI分为AKI组23例和非AKI组94例。计算入院时MPV/PLT、NPAR,采用多因素Logistic回归分析SAP并发AKI的影响因素,采用受试者工作特征(ROC)曲线分析MPV/PLT、NPAR对SAP患者并发AKI的预测价值。结果:与非AKI组比较,AKI组MPV/PLT、NPAR升高(P<0.05)。AKI组心率、呼吸频率快于非AKI组,平均动脉压低于非AKI组,乳酸脱氢酶、血尿素氮(BUN)、血肌酐(Scr)高于非AKI组(P<0.05)。多因素Logistic回归分析显示,BUN、Scr、MPV/PLT、NPAR升高为SAP患者并发AKI的独立危险因素(P<0.05)。ROC曲线分析显示,BUN、Scr、MPV/PLT、NPAR四项联合预测SAP患者并发AKI的AUC大于单独预测。结论:入院MPV/PLT、NPAR升高与SAP患者并发AKI相关,在BUN、Scr基础上联合MPV/PLT、NPAR能提高预测SAP患者并发AKI的效能,可能成为SAP患者并发AKI的辅助预测指标。

Objective:To investigate the predictive value of admission mean platelet volume/platelet count ratio(MPV/PLT)and neutrophil percentage to albumin ratio(NPAR)in patients with severe acute pancreatitis(SAP)complicated by acute kidney injury(AKI).Methods:117 patients with SAP who were admitted to the Department of Intensive Care Medicine of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2019 to December 2022 were selected,and they were divided into 23 patients in AKI group and 94 patients in non-AKI group according to whether they were complicated with AKI.The MPV/PLT and NPAR on admission were calculated,the influencing factors of SAP complicated with AKI were analyzed by multivariate Logistic regression,and the predictive value of MPV/PLT and NPAR on patients with SAP complicated with AKI was analyzed by receiver operating characteristic(ROC)curve.Results:Compared with non-AKI group,MPV/PLT and NPAR in the AKI group were elevated(P<0.05).The heart rate and respiratory rate in the AKI group were faster than those in the non-AKI group,the average arterial pressure was lower than that in the non-AKI group,and the lactate dehydrogenase,blood urea nitrogen(BUN)and serum creatinine(Scr)were higher than those in the non-AKI group(P<0.05).Multiple Logistic regression analysis showed that elevated BUN,Scr,MPV/PLT and NPAR were independent risk factors for patients with SAP complicated with AKI(P<0.05).ROC curve analysis showed that the AUC of BUN,Scr,MPV/PLT and NPAR combined prediction of patients with SAP complicated with AKI was greater than that of single prediction.Conclusion:Elevated admission MPV/PLT and NPAR are associated with patients with SAP complicated with AKI.Combining MPV/PLT and NPAR on the basis of BUN and Scr can improve the efficiency of predicting patients with SAP complicated with AKI,and which may become an auxiliary predictor index of patients with SAP complicated with AKI.