| Objective: To explore the predictive value of stress hyperglycemia ratio(SHR)in acute kidney injury(AKI)in patients with acute myocardial infarction(AMI).And to assess the predictive value of SHR1 and SHR2 for AKI in AMI patients.Methods: A total of 234 patients with acute myocardial infarction met the inclusion and exclusion criteria were enrolled in the First Affiliated Hospital of Shihezi University School of Medicine from January 2021 to December 2021.First,the patients were divided into diabetic and non-diabetic groups,and according to the occurrence of AKI,divided into non-AKI group and AKI group.Through the electronic medical record system,collecting the clinical data of the research subjects(basic information,past medical history,smoking history,biochemical indicators and auxiliary examinations).Use The SPSS 26.0 for statistical analysis to compare clinical data from non-AKI and AKI groups,and use binary logistic regression to analyze the risk factors associated with the occurrence of AKI.Medcalc was used to plot ROC curves,calculate the sensitivity,specificity and area under the curve for the prediction of AKI incidence by admission blood glucose,fasting blood glucose,SHR1 and SHR2,and find the best diagnostic cut-off value of the above indicators in AMI patients to predict AKI,and to compare the predictive value of SHR1 and SHR2.Results: A total of 234 patients with acute myocardial infarction were included in this study.87 patients with diabetes,15(17.2%)patients developed AKI,147 non-diabetic patients,20(13.6%)developed AKI.1.All patientsPatients in the AKI group had higher admission blood glucose,fasting blood glucose,SHR1 and SHR2,with significant differences(P<0.05).In addition,the two groups had statistically significant differences in emergency PCI,leukocytes,neutrophils,CK peak,CK-MB peak,and NT-pro BNP.Multivariate logistic regression analysis showed that SHR1、SHR2 and D-dimer were independent risk factors for AKI in AMI patients.The results of ROC curve analysis showed that SHR1-AUC was 0.817(95%CI 0.761-0.864),SHR2-AUC was 0.749(95%CI 0.688-0.803),admission blood glucose-AUC was 0.698(95%CI 0.635-0.756),fasting blood glucose-AUC was 0.648(95%CI 0.583-0.709),and the four indicators had predictive value for AKI in AMI patients,and the prediction cut-off values were 1.245(SHR1),0.879(SHR2),7.3mmol/L(admission blood glucose),and 5.39mmol/L(fasting blood glucose).Medcalc software was used to further compare the ROC curve of the above four indexes on the occurrence of AKI in patients with AMI.The results showed that the predictive value of SHR1 and SHR2 was basically the same,and the predictive value of admission blood glucose and fasting blood glucose was basically the same.The predictive value of SHR1 was better than that of admission blood glucose(P=0.001),and the predictive value of SHR2 was better than that of fasting blood glucose(P=0.008).2.Diabetic patientsPatients in the AKI group had higher admission blood glucose,fasting blood glucose,SHR1 and SHR2,with significant differences(P<0.05).In addition,the two groups had statistically significant differences in CK peak and NT-pro BNP.Multivariate logistic regression analysis showed that SHR1 and SHR2 was independent risk factor for AKI in patients with AMI and diabetes.The results of ROC curve analysis showed that SHR1-AUC was 0.837(95%CI 0.742-0.908),SHR2-AUC was 0.859(95%CI 0.768-0.925),admission blood glucose-AUC was 0.678(95%CI 0.570-0.774),fasting blood glucose-AUC was 0.727(95%CI 0.621-0.817),and the four indicators had predictive value for the occurrence of AKI,and the prediction cut-off values were 1.265(SHR1),1.036(SHR2),13.0 mmol/L(admission blood glucose),and 9.3 mmol/L(fasting blood glucose).Medcalc software was used to further compare the ROC curve of the above four indexes on the occurrence of AKI in patients with AMI and diabetes.The results showed that the predictive value of SHR1 and SHR2 were basically same,and the predictive value of admission blood glucose and fasting blood glucose were basically same.The predictive value of SHR1 was better than that of admission blood glucose(P=0.009),and the predictive value of SHR2 was better than that of fasting blood glucose(P=0.013).3.Non-diabetic patientsPatients in the AKI group had higher admission blood glucose,fasting blood glucose,SHR1 and SHR2,with significant differences(P<0.05).In addition,the two groups had statistically significant differences in previous PCI,CK peak and CK-MB peak.Multivariate logistic regression analysis showed that SHR1 was an independent risk factor for AKI in non-diabetic patients with AMI.The results of ROC curve analysis showed that SHR1-AUC was 0.809(95%CI 0.737-0.869),SHR2-AUC was 0.665(95%CI 0.582-0.740),admission blood glucose-AUC was 0.801(95%CI 0.727-0.862),fasting blood glucose-AUC was 0.648(95%CI 0.565-0.725),and the four indicators had predictive value for the occurrence of AKI,and the prediction cut-off values were 1.200(SHR1),0.878(SHR2),7.3 mmol/L(admission blood glucose),and 5.3 mmol/L(fasting blood glucose).Medcalc software was used to further compare the ROC curve of the above four indexes on the occurrence of AKI in patients with AMI non-diabetic.The results showed that the predictive value of SHR1 and admission blood glucose were basically same,and the predictive value of SHR2 and fasting blood glucose were basically same.The predictive value of SHR1 was better than that of SHR2(P=0.031),and the predictive value of admission blood glucose was better than that of fasting blood glucose(P=0.025).Conclusions:1.SHR has a good predictive value for AKI in AMI patients,and the predictive value of SHR1 is better than that of SHR2.2.The predictive value of SHR for AKI in AMI patients is better than that of single blood glucose value. |
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