降钙素原与白蛋白比值对腹腔感染引起的脓毒症相关急性肾损伤不良预后的评估价值

The evaluation value of the ratio of procalcitonin to albumin for poor prognosis of sepsis-associated acute kidney injury caused by abdominal infection

目的探讨腹腔感染引起的脓毒症相关急性肾损伤(AKI)的危险因素,并分析其在脓毒症相关AKI病人不良预后中的诊断价值。方法前瞻性分析南京医科大学附属淮安第一医院重症监护室(ICU)2019年1月至2022年12月231例由腹腔感染引起的脓毒症相关AKI病人的临床资料,根据病人随访预后情况将其分为生存组(137例)和死亡组(94例)。采用单因素分析法比较两组病人的临床资料;多因素logistic回归分析脓毒症相关AKI病人不良预后的独立危险因素;受试者操作特征曲线(ROC曲线)评价血清降钙素原(PCT)、C反应蛋白(CRP)、PCT/白蛋白(Alb)、CRP/Alb对脓毒症相关AKI病人不良预后的诊断价值。结果单因素分析显示,231例脓毒症相关急性肾损伤,小肠坏死或穿孔疾病引起的病死率明显高于回盲阑尾疾病的病死率(31.9%比11.7%)(P<0.001);死亡组PCT浓度显著高于生存组[28.65(18.73,78.97)mg/L比8.0(1.05,21.73)mg/L](P<0.001);同样,死亡组CRP浓度显著高于生存组[224.37(180.10,263.15)mg/L比186.3(136.33,235.84)mg/L](P<0.001);死亡组PCT/Alb和CRP/Alb比值均显著高于生存组[2.29(0.73,3.78)比0.25(0.04,0.53)和10.78(6.91,13.79)比5.75(5.30,10.92)](均P<0.001);多因素logistic回归分析显示,PCT/Alb、CRP/Alb是脓毒症诱导AKI病人不良预后的独立危险因素。进一步的ROC曲线显示,PCT/Alb预测脓毒症AKI病人不良预后的准确性均高于CRP/Alb,曲线下面积(0.86比0.74)、特异度(84.7%比61.3%)、灵敏度(78.7%比75.5%)。结论PCT/Alb不仅是评估腹腔感染引起的脓毒症相关急性肾损伤病人不良预后的独立危险因素,更能为临床改善此类疾病管理和降低病死率方面提供一定帮助。

Objective To investigate the risk factors of sepsis-associated acute kidney injury(AKI)caused by abdominal infection and to analyze its diagnostic value for poor prognosis of patients with sepsis-associated AKI.Methods The clinical data of 231 patients with sepsis-associated AKI caused by abdominal infection in the intensive care unit(ICU)of the Affiliated Huai'an NO.1 People's Hospital of Nanjing Medical University from January 2019 to December 2022 were prospectively analyzed,and they were assigned into survival group(n=137)and non-survival group(n=94)according to the follow-up prognosis.Single factor analysis was used to compare the clinical data of the two groups.Multivariate logistic regression was used to analyze the independent risk factors for poor prognosis of sepsis-associated AKI patients.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of serum procalcitonin(PCT),C-reactive protein(CRP),PCT/serum albumin(Alb)and CRP/Alb for poor prognosis of the patients.Results Univariate analysis results showed that among 231 patients,the mortality rate of intestinal necrosis or perforation was significantly higher than that of ileocecal appendix diseases(31.9%vs.11.7%)(P<0.001).The PCT concentration in the non-survival group was significantly higher than that in the survival group[28.65(18.73,78.97)mg/L vs.8.0(1.05,21.73)mg/L](P<0.001);Similarly,the CRP concentration in the non-survival group was significantly higher than that in the survival group[224.37(180.10,263.15)mg/L vs.186.3(136.33,235.84)mg/L](P<0.001).The ratios of PCT/Alb and CRP/Alb in the non-survival group were significantly higher than those in the survival group[2.29(0.73,3.78)vs.0.25(0.04,0.53);10.78(6.91,13.79)vs.5.75(5.30,10.92)](all P<0.001).Multivariate lo‐gistic regression analysis results showed that PCT/Alb and CRP/Alb were independent risk factors for poor prognosis of sepsis-associat‐ed AKI patients.The further ROC curve analysis showed that PCT/Alb was more accurate than CRP/Alb in predicting the poor progno‐sis of patients,with the area under the curve being(0.86 vs.0.74),specificity(84.7%vs.61.3%)and sensitivity(78.7%vs.75.5%).Con⁃clusion The ratio of PCT to Alb is an independent risk factor for the poor prognosis of patients with sepsis-induced AKI,which pro‐vides potential for improving the treatment of such disease and reducing the mortality rate.