| Objective: Acute pancreatitis is an inflammatory disorder of the pancreas and is one of the leading causes of hospitalization for patients with gastrointestinal disorders.As the incidence and death-rate of acute pancreatitis increased,the need for how to manage it effectively is also increasing.The aim of this study was to monitor and analyze the dynamic changes of three indicators of serum mi R-29 a,LCN2 and NLR,and further explore the clinical significance of the above indicators in terms of early prediction and severity of acute kidney injury complicated by severe acute pancreatitis.Methods: In this study,126 patients with SAP were screened according to the inclusion and exclusion criteria by looking back on analyzing the data of patients hospitalized at the Second Hospital of Anhui Medical University from January 2018 to March 2022.All patients were treated with routine symptomatic management within 7 days after admission.The enrolled patients were segmented into the group without AKI(SAP group,75 cases)and the group with concomitant AKI(SAP & AKI group,51 cases)according to whether they had concomitant acute kidney injury,and then the SAP &AKI group was further divided into AKI I group(21 cases),AKI II group(18 cases),and AKI III group(12 cases)according to the severity of kidney injury.The age,gender,BMI,etiology,AMY,LPS,CRP,neutrophil count,lymphocyte count,Hct,blood Ca2+,urine volume,creatinine of the admitted patients were collected,and the NLR of the patients was calculated based on the neutrophil/lymphocyte ratio,and the APACHE II score and Ranson score were performed in combination with the clinical information on the admitted patients.SPSS 23.0 software was used for statistical analysis of the data.Results:(1)The differences in age,gender,BMI,etiology,AMY,LPS,and Hct between patients in the SAP group and SAP & AKI group were not statistically significant(P >0.05),and patients in the SAP & AKI group had significantly higher CRP,NLR,creatinine,APACHE II score,and Ranson score,and markedly lower blood Ca2+ and24 h urine volume than those in the SAP group.SAP group,and the differences were statistically significant(P < 0.05).(2)Serum mi R-29 a and LCN2 levels were significantly higher in the SAP & AKI group compared with the SAP group(P <0.05).Multivariate logistic regression analysis of all statistically different indicators revealed that peripheral blood mi R-29 a,LCN2,and NLR were independent risk factors for AKI complicated by SAP(P < 0.05).(3)The differences in age,gender,BMI,etiology,AMY,LPS,and Hct between SAP group,SAP & AKI I group,SAP & AKI II group,and SAP & AKI III group were not statistically significant(P > 0.05),while the differences in CRP,NLR,blood Ca2+,24 h urine volume,creatinine,APACHE II score,and Ranson score between the four groups The differences were statistically significant(P < 0.05).(4)On days 1,4 and 7 after admission,the blood mi R-29 a,LCN2 and NLR of the four groups showed an increasing trend with increasing severity of AKI,and the differences were statistically significant(P < 0.01),and at a certain time point after admission(days 1,4 and 7),the differences of the above three indexes were also statistically significant(P < 0.01)in the four groups.(5)The efficacy of blood mi R-29 a,LCN2 and NLR in early prediction of AKI complicated by SAP using ROC curves:(1)SAP & AKI I group: the sensitivity of mi R-29 a was 0.824,the specificity was 0.660,and the area under the curve was 0.864;the sensitivity of LCN2 was 0.922,the specificity was 0.827,and the area under the curve was The sensitivity of NLR was0.804,the specificity was 0.780,and the area under the curve was 0.818;the predicted sensitivity/specificity/area under the curve of AKI increased to 0.953,0.872,and 0.942,respectively,when the three were combined.The sensitivity of LCN2 was 0.967,the specificity was 0.781,and the area under the curve was 0.801;the sensitivity of NLR was 0.933,the specificity was 0.664,and the area under the curve was 0.857;the predicted sensitivity/specificity/area under the curve of AKI increased to 0.956,0.914,0.914,and 0.942,respectively.(3)SAP & AKI III group: the sensitivity of mi R-29 a was0.750,the specificity was 0.907,and the area under the curve was 0.846;the sensitivity of LCN2 was 0.917,the specificity was 0.842,and the area under the curve was 0.931;the sensitivity of NLR was 0.917,the specificity was 0.763,and the area under the curve was 0.925.The sensitivity/specificity/area under the curve of NLR was 0.917,the specificity was 0.763,and the area under the curve was 0.925;the sensitivity/specificity/area under the curve of AKI increased to 0.983,0.924,and 0.992,respectively,when the three were combined.(6)Correlation analysis showed that mi R-29 a,LCN2,and NLR were positively correlated with blood creatinine(r values of0.551,0.605,and 0.622,respectively)and negatively correlated with 24-h urine output(r values of-0.516,-0.626,and-0.585,respectively),with statistically significant differences(P < 0.01).(7)Statistically,the prognosis of 51 patients with SAP & AKI was divided into death and improvement groups,including 13 cases in the death group and38 cases in the improvement group,and the differences between NLR,blood Ca2+,urine volume,creatinine,mi R-29 a,NLR,and APACHE II scores were statistically significant between the samples of the two groups(P < 0.05).Further multivariate logistic regression analysis of the above indicators showed that peripheral blood mi R-29 a,LCN2,and NLR were independent risk factors for death from AKI complicated by SAP(P < 0.05).Conclusion: 1.Peripheral blood mi R-29 a,LCN2,and NLR were correlated with SAP& AKI patients and were independent influencing factors of AKI complicated by SAP,which is valuable for predicting the occurrence of AKI.2.Peripheral blood mi R-29 a,LCN2,and NLR were significantly elevated in patients with SAP & AKI and increased with AKI.They have early predictive value for predicting AKI complicated by SAP.3.Peripheral blood mi R-29 a,LCN2,and NLR were all effective in predicting the severity of SAP and AKI,but the combination of the three was the best.4.Peripheral blood mi R-29 a,LCN2,and NLR are related to the prognosis of patients with SAP & AKI and they are independent risk factors for death from AKI complicated by SAP,and are valuable in predicting the occurrence of AKI. |
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