血清尿酸/白蛋白比值预测ST段抬高型心肌梗死患者PCI术后急性肾损伤的多模型研究

A multi-model study of serum uric acid/albumin ratio in predicting acute kidney injury after PCI in STEMI patients

目的探讨血清尿酸/白蛋白比值(sUAR)预测急性ST段抬高型心肌梗死(STEMI)患者PCI后急性肾损伤(AKI)的模型。方法回顾性选取2021年7月—2023年7月都昌县人民医院收治的166例STEMI患者,根据PCI术后是否发生AKI分为发生组(34例)与未发生组(132例)。比较两组基线资料、生化指标及sUAR。采用单因素、多因素Logistic回归分析PCI术后AKI危险因素,构建列线图预测模型。建立ROC曲线分析该模型的预测效能。结果两组年龄、高血压、Killip分级、NLR、sUAR、LVEF、造影剂剂量、PCI手术时长、多支血管病变比较,差异有统计学意义(P<0.05)。年龄偏大(OR=1.066)、Killip分级≥2(OR=7.174)、NLR升高(OR=4.440)、sUAR升高(OR=2.071)、造影剂剂量偏高(OR=1.104)、PCI手术时长增加(OR=1.044)为PCI术后AKI的独立危险因素(P<0.05)。NLR、sUAR、“NLR+sUAR”及列线图预测模型的AUC分别为0.807(95%CI:0.717~0.897)、0.810(95%CI:0.729~0.892)、0.877(95%CI:0.808~0.946)、0.940(95%CI:0.901~0.979)。Bootstrap(B=1000)内部验证显示,Bias-corrected预测曲线与Ideal线基本重合,列线图风险预测模型预测能力较好;决策曲线显示,该模型的阈值概率范围为0.01~0.90,其净收益率>0。结论年龄、Killip分级、NLR、sUAR、造影剂剂量、PCI手术时长与STEMI患者PCI术后AKI密切相关。列线图预测模型相较于单项对PCI术后AKI有更高预测效能,临床应用价值较好。

Objective To explore the potential of serum uric acid/albumin ratio(sUAR)as a predictive model for acute kidney injury(AKI)after PCI in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 166 STEMI patients admitted to Duchang Hospital from July 2021 to July 2023 were retrospectively selected and divided into two groups:the occurrence group(n=34)and the non-occurrence group(n=132)based on whether AKI occurred after PCI.Baseline data,biochemical indexes,and sUAR were compared between the two groups.Univariate and multivariate logistic regression were utilized to analyze the risk factors for AKI following PCI,and a nomogram prediction model was developed.The ROC curve was developed to analyze the predictive efficiency of the model.Results There were significant differences in age,hypertension,Killip classification,NLR,sUAR,LVEF,contrast agent dose,PCI operation time,and multi-vessel lesions between the two groups(P<0.05).Older age(OR=1.066),Killip grade≥2(OR=7.174),elevated NLR(OR=4.440),increased sUAR(OR=2.071),high contrast agent dose(OR=1.104),and prolonged PCI operation duration(OR=1.044)were identified as the independent risk factors for AKI following PCI(P<0.05).The AUC values for the NLR,sUAR,“NLR+sUAR”and nomogram prediction models were 0.807(95%CI:0.717~0.897),0.810(95%CI:0.729~0.892),0.877(95%CI:0.808~0.946),0.940(95%CI:0.901~0.979),respectively.Bootstrap(B=1000)internal validation indicated that the bias-corrected prediction curve was closely aligned with the ideal line,and the nomogram risk prediction model had good predictive ability.The decision-making curve analysis revealed that the model’s threshold probability ranged from 0.01 to 0.90 with a net return more than 0.Conclusion AKI after PCI in STEMI patients are closely related to such indicators as age,Killip classification,NLR,sUAR,contrast agent dose,and PCI operation duration.The nomogram prediction model demonstrates higher predictive efficiency for AKI after PCI compared to the single model and it holds better clinical application value.