| Objective: Liver cirrhosis is a common disease of digestive system,which is easy to be complicated with a variety of complications in the late stage.Acute kidney injury(AKI)occurs on the basis of chronic liver disease and liver cirrhosis,which is related to poor clinical prognosis.By analyzing the risk factors of liver cirrhosis complicated with AKI,this paper explores the diagnostic value of cystatin C(Cys-C)and neutrophil / lymphocyte ratio(NLR)in liver cirrhosis AKI,so as to provide basis for early clinical identification of AKI and intervention measures.Methods:The clinical data of 300 patients with liver cirrhosis diagnosed in the Department of Gastroenterology of the second hospital of Hebei Medical University from December 2019 to May 2021 were studied retrospectively.They were divided into simple liver cirrhosis group and liver cirrhosis complicated with acute renal injury group.Evaluate the general data,laboratory indexes and complications of the two groups.Application IBM spss21.0 for statistical analysis,the measurement data adopts two independent sample t-test or Mann-Whitney U-test,and the counting data adopts Chi-square test or Fisher exact test.Logistic regression analysis was used to screen the independent risk factors of AKI in patients with liver cirrhosis.Linear correlation was used to analyze the correlation between Cys-C,NLR and SCr.Using Med Calc to draw the receiver operating characteristic curve(ROC curve).The area under the curve is used to evaluate the diagnostic efficacy of Cys-C,NLR and SCr for AKI in patients with liver cirrhosis,and to compare the area under the ROC curve among the three.P<0.05 the difference was considered to be statistically significant.Results: 1.The prevalence of AKI in hospitalized patients with liver cirrhosis was about 20.3%,including 191 patients with viral hepatitis(63.3%),accounting for the highest proportion in the distribution of etiology.2.Logistic regression analysis showed that Cys-C,NLR,SCr,age,total bilirubin,prothrombin time,procalcitonin,Child-Pugh score and MELD score increased,combined with moderate and large amount of ascites,hepatic encephalopathy,spontaneous bacterial peritonitis and other infections were independent risk factors of AKI in liver cirrhosis.3.Correlation analysis showed that Cys-C was strongly correlated with SCr,NLR was weakly correlated with SCr,and the correlation coefficients were 0.653 and 0.325 respectively.4.ROC curve was used to evaluate the diagnostic efficacy of Cys-C,NLR and SCr for AKI in liver cirrhosis.The area under the Cys-C curve is 0.972,the sensitivity is 88.52%,the specificity is 97.91%.When the critical value is 1.79mg/L,the value of diagnosing AKI is the highest.The area under NLR curve was 0.782,the sensitivity was 68.85%,the specificity was 79.08%.When NLR>3.86,the diagnostic efficacy of AKI was the greatest.The area under the SCr curve was 0.954,the sensitivity was 90.16%,and the specificity was 90.38%.As the SCr value was 89.0umol/L,the prediction efficiency of AKI was the highest.5.Med Calc was used to analyze the area under ROC curve of Cys-C,NLR and SCr.The results showed that there was no significant difference in the area under ROC curve between Cys-C and SCr(P=0.11),and there was significant difference in the area under ROC curve between NLR and Cys-C.Besides,the results suggested that the efficacy of Cys-C and SCr in diagnosing AKI was not statistically significant(P<0.01),and the diagnostic value of NLR was not as good as the first two.Conclusions:1.Cys-C,NLR,SCr,age,total bilirubin,prothrombin time,procalcitonin,Child-Pugh score and MELD score increased,combined with moderate and large amount of ascites,hepatic encephalopathy,spontaneous bacterial peritonitis and other infections are the independent risk factors of AKI in liver cirrhosis.2.NLR is inferior to Cys-C and SCr in the diagnosis of AKI.Compared with SCr and Cys-C has no significant difference in the diagnostic value of AKI.When Cys-C>1.79 mg/L and SCr>89.0 umol/L,it is necessary to be alert to the occurrence of AKI. |
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