Correlation And Predictive Value Of Hs-CRP,NLR,RDW With Early Renal Insufficiency In Patients With Atrial Fibrillation

Objective:To explore the relationship between high-sensitivity C-reactive protein(hs-CRP),neutrophil to lymphocyte ratio(NLR),red blood cell volume distribution width(RDW)and early renal insufficiency in patients with atrial fibrillation(AF)and Its predictive value for early renal insufficiency in patients with AF.Methods:207 patients with AF who were hospitalized in the cardiology department of our hospital from September 2017 to July 2020 were included,including 125 cases of paroxysmal AF and 82 cases of persistent(including persistent and long-term persistent)AF.The average age was(68.57±6.705)years old.There were 104 males and 103females.According to e GFR,it is divided into normal renal function group(e GFR≥80ml/(min*1.73m~2),n=102)and early renal insufficiency group(50ml/(min*1.73m2)≤e GFR<80ml/(min*1.73m~2),n=105).Record clinical data,including age,gender,height,weight,concomitant diseases,blood routine,liver function,blood creatinine,homocysteine,glucose,glycosylated hemoglobin,blood lipids,myocardial enzymes,ions,uric acid,hs-CRP and other biochemicals,Calculate the estimated glomerular filtration rate(e GFR)using the CKD-EPI formula and calculate the body mass index(BMI)and NLR.Use SPSS 23.0 for statistical analysis,Spearman correlation analysis to observe the correlation between hs-CRP,NLR,RDW and the occurrence of early renal insufficiency in AF patients,and binary logistic regression analysis to analyze whether hs-CRP,NLR,RDW are early renal function of AF patients Independent risk factors for the occurrence of insufficiency,a receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of hs-CRP,NLR,RDW and any combination of the three on the occurrence of early renal insufficiency in AF patients.Results:1.Comparison between the two groups,age,sex,BMI,combined with coronary heart disease,combined with diabetes,Glu,ALT,AST,Hcy,TG,TC,HDL-C,LDL-C,CK,CK-MB,K,Na,Cl,Ca,P,WBC,AO,LVDD,LVEF,COL,SV,FS,EDV,ESV and other indicators were not statistically different(P>0.05);AF classification,combined with hypertension,combined with heart failure,UA,Hb A1C,LDH,HBDH,hs-CRP,NLR,RDW,and LAD were statistically significant(P<0.05);2.Persistent AF,combined with hypertension,combined with heart failure,Hb A1C,LDH,HBDH,UA,hs-CRP,NLR,RDW,and LAD are all associated with early renal insufficiency in patients with AF Positive correlation(p<0.05);3.After adjusting for related factors by binary logistic regression analysis,persistent AF,hypertension,hs-CRP,NLR,and RDW are all independent risk factors for early renal insufficiency in AF patients(OR=4.016,95%CI:1.243-12.972,P=0.020;OR=4.440,95%CI:1.447～13.623,P=0.009;OR=1.224,95%CI:1.056～1.419,P=0.007;OR=2.005,95%CI:1.158～3.472,P=0.013;OR=2.869,95%CI:1.186～6.940,P=0.019);4.hs-CRP,NLR,RDW,hs-CRP+NLR,hs-CRP+RDW,NLR+RDW and hs-CRP+NLR+RDW combined detection can predict the occurrence of early renal insufficiency in AF patients,with AUC values of 69.3(95%CI:62.2-76.4,P<0.001),71.3(95%CI:64.3-78.2,P<0.001),76.1(95%CI:69.6-82.6,P<0.001),76.8(95%CI:70.4～83.1,P<0.001),81.4(95%CI:75.6-87.2,P<0.001),79.1(95%CI:73.0-85.2,P<0.001),82.4(95%CI:76.7-88.0,P<0.001).The best Cut-off values of hs-CRP,NLR,and RDW are 6.34mg/L,2.830,13.15%;the sensitivity and specificity of each index to predict the occurrence of early renal insufficiency in AF patients are:hs-CRP(57.1%,77.5%),NLR(53.3%,84.3%),RDW(81.9%,61.8%),hs-CRP+NLR(58.1%,84.3%),hs-CRP+RDW(72.4%,77.5%)),NLR+RDW(58.1%,89.2%),hs-CRP+NLR+RDW(65.7%,87.3%).Conclusion:1.Persistent AF,combined hypertension,combined heart failure,Hb A1C,LDH,HBDH,UA,hs-CRP,NLR,RDW,and LAD were all positively correlated with the occurrence of early renal insufficiency in AF patients;2.Persistent AF,hypertension,hs-CRP,NLR,RDW are independent risk factors for early renal insufficiency in AF patients;3.hs-CRP,NLR,RDW,hs-CRP+NLR,hs-CRP+RDW,NLR+RDW and hs-CRP+NLR+RDW combined detection can predict the occurrence of early renal insufficiency in AF patients,when tested individually,the predictive value of RDW and NLR is higher than that of hs-CRP;when the three are tested in combination,the predictive value of the three is higher than that of independent testing and any combination of the two.The combined test of hs-CRP+NLR+RDW is valuable in predicting early renal insufficiency in patients with AF maximum.