Predictive Value Of Cystatin C,NLR Combined With ISTH Score In Patients With Severe Pneumonia Complicated By Acute Kidney Injury

Objective:By retrospective analysis of clinical data of severe pneumonia patients admitted to the First Hospital of Shanxi Medical University from May 2018 to May 2022,to investigate the predictive value of cystatin C,neutrophil-tolymphocyte ratio(NLR)combined with ISTH score in patients with severe pneumonia complicated by acute kidney injury(AKI).Methods:The electronic medical records of patients with severe pneumonia admitted to the Department of Respiratory and Critical Care Medicine,the Department of Intensive Care Medicine and the Department of Geriatrics in the First Hospital of Shanxi Medical University from May 2018 to May 2022 were consulted.According to the inclusion and exclusion criteria,233 patients with severe pneumonia were screened out,and the relevant data were retrospectively analyzed.According to KDIGO guidelines,patients were divided into severe pneumonia AKI group(n=90)and non-AKI group(n=143).General data,laboratory test results,cystatin C,NLR and ISTH scores of the two groups were compared.Multivariate Logistic regression analyzed the risk factors of AKI in patients with severe pneumonia,plotted the receiver operating characteristics(ROC)curve,and evaluated the predictive value of cystatin C,NLR and ISTH score in patients with severe pneumonia complicated by AKI.Results:1.There were 233 patients with severe pneumonia,including 90 cases(38.63%)in AKI group and 143 cases(61.37%)in non-AKI group.In severe pneumonia AKI group,there were 54 males(60%)and 36 females(40%),with an average age of(72.84±14.91)years.In the non-AKI group,there were 98 males(68.53%)and 45 females(31.47%),with an average age of(70.82±14.33)years.There were no significant differences in age,gender,length of hospital stay,mean arterial pressure,body mass index and underlying diseases,including coronary heart disease,hypertension,diabetes,cerebral infarction and COPD(P > 0.05).APACHE II score and in-hospital mortality of patients with severe pneumonia in AKI group were higher than those in non-AKI group,and the differences were statistically significant(P < 0.05).2.There were statistically significant differences in D-dimer and procalcitonin between 2 groups(P < 0.05),while there were no statistically significant differences in oxygenation index,potassium ion,sodium ion,chloride ion,fasting blood glucose,white blood cell count,platelet count,alanine transaminase and aspartate transaminase between2 groups(P > 0.05).3.Cystatin C,NLR and ISTH scores of patients with severe pneumonia in AKI group were significantly higher than those in non-AKI group(P < 0.05).4.Multivariate Logistic regression analysis showed that cystatin C,NLR,D-dimer,ISTH score and APACHE II score were risk factors for severe pneumonia complicated with AKI.5.The best cut-off values of cystatin C,NLR,and ISTH scores for predicting AKI in patients with severe pneumonia were 2.730mg/L,9.605,and 3.0,respectively.The AUC was 0.827(95%CI: 0.773-0.881),0.688(95%CI: 0.619-0.756),0.835(95%CI:0.783-0.887),sensitivity was 67.8%,71.1%,73.3%,and specificity was 93.0%,59.4%,and 80.4%,respectively.Cystatin C,NLR combined with ISTH score predicted the highest AUC of severe pneumonia complicated by AKI,which was 0.889(95% CI:0.846-0.932),and the predictive value of cystatin C,NLR,and ISTH scores was better than that of individual assessment,and the differences were statistically significant(P <0.05).Conclusion:Cystatin C,NLR,D-dimer,ISTH score and APACHE II score are risk factors for AKI in patients with severe pneumonia.Cystatin C,NLR,and ISTH scores have high predictive value for patients with severe pneumonia complicated by AKI,and the combined prediction value of the three is higher.