Establishment Of Risk Assessment Model And Prognosis Analysis Of Acute Pancreatitis Complicated With Acute Renal Injury

Background and purposeTo analyze the clinical characteristics and risk factors of patients with acute pancreatitis(AP)complicated with acute kidney injury(AKI)by retrospectively analyzing,and to screen and establish the relevant risk prediction models,so as to provide reference basis for early layered diagnosis and treatment and prognosis judgment of the disease.MethodThe clinical data of 217 patients who were diagnosed with acute pancreatitis and hospitalized in the First Affiliated Hospital of Zhengzhou University from December 2019 to December 2021 were collected on admission.According to the diagnostic criteria of acute renal injury(AKI),the patients of acute pancreatitis were divided into AKI group(experimental group)and non-acute renal injury group(control group).To explore the differences in basic vital signs,demographics,laboratory indexes,treatment process,complications and prognosis between the two groups.At the same time,univariate and multivariate logistic analysis were carried out to establish the risk assessment model of AP complicated with AKI.Then,we compare it with the commonly used acute pancreatitis scoring system to evaluate the clinical application value of the model.According to the prognosis of patients,they were divided into survival group and death group to explore the factors affecting the prognosis of acute pancreatitis patients.Result1.After statistical analysis,the drinking rate,disease severity,peritoneal effusion,acute respiratory distress syndrome(ARDS),continuous renal replacement therapy(CRRT)and mortality in AP complicated with AKI group were significantly higher than those in the control group(P<0.05).The mean arterial pressure,heart rate,respiratory rate,arterial pH value,lactic acid,platelet count,number of monocytes,platelet distribution width,procalcitonin,C-reactive protein,blood amylase,serum K+,serum Ga2+,urea,albumin,triglyceride,Pt,APTT,FIB and D-dimer in AP complicated with AKI group on admission were also different from those in the control group(P<0.05).There was no significant difference in other clinical data.2.The prediction model equation of AP complicated with AKI was constructed by univariate and multivariate logistic analysis:y=25.240+2.325×ARDS(1 or 0)+0.241×MAP-0.003×Amylase+0.008×Uric acid-0.290×Albumin+0.289×D-dimer.The Hosmer Lemeshow Test shows that the model has a high degree of fit with the original data.The sensitivity and specificity of the model were 76.6%and 93.7%,respectively3.This study finds that there are significant differences in PLR(platelet count/lymphocyte count)between AP complicated with AKI group and control group.In this study,the clinical datas of patients were included in the clinical commonly used scoring system of acute pancreatitis,and then we count the relevant scores.Using receiver operating characteristic(ROC)curve,the diagnostic efficacy of different scoring systems for AP complicated with AKI was compared and observed.The area under ROC curve(AUC)of BISAP score,SOFA score,qSOFA score and NWES score were 0.791,0.800 and 0.690、0.730 respectively;The sensitivity was 54.4%,50.6%,79.7%and 49.9%respectively;The specificity was 87.7%,96.8%,47.6%and 83.5%respectively.These results show that SOFA score has a good predictive ability for AP complicated with AKI.4.Draw the receiver operating characteristic(ROC)curves of evaluation model,SOFA score and PLR,and compare the diagnostic efficacy of evaluation model,SOFA score and PLR in AP complicated with AKI at the same time.The area under ROC curve(AUC)of risk assessment model,SOFA score and PLR were 0.792,0.961,0.800 and 0.380 respectively;The sensitivity was 88.6%,50.6%and 41.8%respectively;The specificity was 92.8%,96.8%and 36.2%respectively.This result shows that the evaluation model constructed in this study has good prediction ability.5.After statistical analysis of the outcome of patients,Advanced age、ARDS and the decreased hemoglobin are the risk factors affecting the prognosis of acute pancreatitis.Conclusion1.ARDS and Mean Arterial Pressure,serum amylase,albumin,uric acid,D-dimer on admission are the risk factors of AP complicated with AKI.The logistic evaluation model constructed by analysis has good predictive value and certain clinical application value for AP complicated with AKI.2.In acute pancreatitis,ARDS,decreased mean arterial pressure,increased amylase,hypoproteinemia,hyperuricemia and blood hypercoagulability may participate in and affect the occurrence and development of AKI.Appropriate clinical intervention may be helpful to prevent the occurrence of AKI.