Predictive value of prognostic nutritional index combined with PCT，CysC，and RBP levels for acute pancreatitis complicated with acute kidney injury

doi:10.3877/cma.j.issn.2095-2015.2024.06.010

Abstract

Abstract:

Objective

To investigate the predictive value of prognostic nutritional index （PNI），serum procalcitonin （PCT），serum cystatin C （CysC），and serum retinol binding protein （RBP） for patients with acute pancreatitis （AP） complicated with acute kidney injury （AKI）.

Methods

A retrospective analysis was conducted on 350 patients with AP admitted to Wuxi Xishan People's Hospital from June 2022 to June 2024. Patients were divided into two groups based on whether they had concurrent AKI： the AP group and the AP+AKI group. The differences in PNI，PCT，CysC，and RBP levels between the two groups were compared，and their correlations with AP evaluation indicators APACHEⅡ score，Ranson score，and Balthazar CTSI score were analyzed through Spearson analysis. The predictive abilities of PNI，PCT，CysC，and RBP levels for AP combined with AKI were evaluated through ROC curve and multivariate logistic analysis.

Results

The PNI level，APACHE Ⅱ score，Ranson score，and Balthazar CTSI of patients in the AP group were significantly higher than those in the AP+AKI group，while the serum PCT，CysC，and RBP levels were significantly lower than those in the AP+AKI group （P＜0.05）；Spearson correlation analysis showed that PNI was negatively correlated with APACHE Ⅱ score，Ranson score，and Balthazar CTSI score，while PCT，CysC，and RBP were positively correlated with APACHE Ⅱscore，Ranson score，and Balthazar CTSI score （P＜0.05）. The ROC curve showed that the area under the PNI+PCT+CysC+RBP joint curve was 0.923，with a 95% confidence interval of 0.861-0.984 （P＜0.05）.Multivariate logistic analysis showed that PNI [OR=0.425，95% CI （0.193-0.755）]，PCT [OR=4.632，95%CI （2.131-5.085）]，CysC [OR=2.076，95% CI （1.635-2.978）]，and RBP [OR=3.261，95% CI （2.478-4.639）]were independent risk factors for AKI in AP patients.

Conclusion

PNI，PCT，CysC，and RBP levels can be used as indicators for predicting AKI in AP patients，which are conducive to early detection of high-risk patients with AP prone to AKI，optimization of treatment strategies，and improvement of patient prognosis，and have high clinical significance for promotion.

Key words: Acute pancreatitis, Acute kidney injury, Prognostic nutritional index, Procalcitonin, Cystatin C, Retinol binding protein

Yan Shen, Junfeng Zhang, Chunfang Tang. Predictive value of prognostic nutritional index combined with PCT，CysC，and RBP levels for acute pancreatitis complicated with acute kidney injury[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 536-540.

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URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2024.06.010

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2024/V14/I06/536

Figures/Tables 6

组别	例数	男/女（例）	年龄（岁， $\bar{x}$ ±s）	初诊病程（h， $\bar{x}$ ±s）	高血压（例）	糖尿病（例）	高脂血症（例）
AP组	300	162/138	45.33±5.11	19.18±4.33	149	51	88
AP+AKI组	50	31/19	49.29±7.19	20.61±5.15	29	13	19
t/χ²		1.109	0.102	0.511	1.191	2.323	1.517
P		0.357	0.794	0.472	0.289	0.164	0.246

组别	例数	男/女（例）	年龄（岁， $\bar{x}$ ±s）	初诊病程（h， $\bar{x}$ ±s）	高血压（例）	糖尿病（例）	高脂血症（例）
AP组	300	162/138	45.33±5.11	19.18±4.33	149	51	88
AP+AKI组	50	31/19	49.29±7.19	20.61±5.15	29	13	19
t/χ²		1.109	0.102	0.511	1.191	2.323	1.517
P		0.357	0.794	0.472	0.289	0.164	0.246

组别	例数	尿素氮（mmol/L）	谷丙转氨酶（U/L）	碱性磷酸酶（U/L）	预后营养指数	血清降钙素原（μg/L）	血清胱抑素C（mg/L）	血清视黄醇结合蛋白（mg/L）
AP组	300	11.61±1.67	255.51±20.91	219.92±34.61	41.03±7.92	1.24±0.55	1.42±0.37	82.37±11.53
AP+AKI组	50	13.18±1.86	232.88±24.67	237.14±31.85	30.92±5.28	4.02±0.96	5.82±1.14	321.59±51.82
t		0.716	1.885	2.021	12.437	33.109	27.483	21.054
P		0.374	0.187	0.109	0.002	＜0.001	＜0.001	＜0.001

组别	例数	APACHE Ⅱ	Ranson	Balthazar CTSI
AP组	300	10.12±2.06	3.26±0.94	4.22±1.05
AP+AKI组	50	16.99±3.01	6.26±1.27	8.23±1.89
t		13.026	10.255	14.851
P		0.007	0.011	0.002

病情评价指标	检测指标	标准误	P	β	OR	95%CI
APACHE Ⅱ	PCT	0.863	0.002	1.566	4.544	1.542～8.475
	PNI	-0.333	0.011	0.953	3.424	1.326～7.264
	CysC	0.738	0.004	1.414	4.367	1.447～8.055
	RBP	0.212	0.031	0.841	2.464	1.469～6.364
Ranson	PCT	0.728	0.005	1.424	4.373	1.666～8.625
	PNI	-0.648	0.007	0.913	3.585	1.352～7.673
	CysC	0.725	0.006	1.177	4.174	1.637～8.474
	RBP	0.393	0.023	0.724	2.225	1.157～5.644
Balthazar CTSI	PCT	0.942	0.001	1.847	5.374	1.953～9.647
	PNI	-0.663	0.008	0.956	3.611	1.553～7.215
	CysC	0.734	0.005	1.342	4.3346	1.263～8.036
	RBP	0.322	0.023	0.811	2.732	1.043～5.626

变量	β	标准误	Wald χ ²	P	OR	95%CI
PNI	0.123	0.624	5.955	0.008	0.425	0.193～0.755
PCT	0.852	0.414	6.855	0.001	4.632	2.131～5.085
CysC	0.583	0.713	3.811	0.013	2.076	1.635～2.978
RBP	0.989	0.824	6.224	0.003	3.261	2.478～4.639

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