Influencing Factors Of Acute Kidney Injury Complicated By Severe Acute Pancreatitis And Their Prediction Model

Abstract:Objective:To explore and analyze the influencing factors of severe acute pancreatitis?SAP?complicated with acute kidney injury?AKI?,establish a predictive model and evaluate its value,and predict the prognosis of the disease.Methods:A retrospective analysis of 83 patients with SAP complic-ated with AKI admitting to the Affiliated Hospital of Southwest Medical University from January 2013 to May 2018 as the observation group.225patients with SAP without complicated with AKI were selected as the control group.The etiology,clinical data,laboratory tests,and mortality of the two groups were analyzed.Multivariate logistic regression analysis was performed on the statistically significant indicators,Multivariate logistic regression analysis was performed on the statistically significant indicators,and the predictive model was established,Calculating the predictor of the predicted value,and the receiver operating characteristic curve?ROC curve?was drawn to evaluate its value.Results:The most common cause of SAP is cholelithiasis,followed by hyperlipidemia.There were significant differences between two groups in C-reactive protein?CRP?,procalcitonin?PCT?,serum albumin?ALB?,triglyceride?TG?,serum calcium(Ca²⁺),pH,partial pressure of oxygen?PO₂?,troponin I,pancreatic amylase,lipase,Ranson score,acute Physiology and Chronic Health Evaluation?APACHE??score,CT severity index?CTSI?score?all P<0.05?.Multifactorial logistic regression analysis showed that CRP,ALB,APACHE II score,PO₂ and Ca²⁺were the influencing factors of SAP complicated with AKI?all P<0.05?.Among them,CRP?OR=1.017,P=0.000?and APACHE II score?OR=3.914,P=0.002?were independent risk factors,ALB?OR=0.900,P=0.011?.PO₂?OR=0.502,P=0.001?and Ca²⁺?OR=0.052,P=0.000?were protective factors.According to the influencing factors,the established predictive model formula was:LogitP=0.120×CRP-0.091×ALB+1.354×APACHE?score-0.012×PO₂-2.860×Ca²⁺-5.242,Probabilistic model for predicting concurrent AKI:P=1/{1+Exp(-0.120×CRP+0.091×ALB-1.354×APACHEII score+0.012×PO₂+2.860×Ca²⁺+5.242)},The area under the ROC curve was 0.971,the specificity was 90%and the sensitivity of the model was92%and when the Yoden index was 0.82.It was proved that the model could predict the risk of SAP complicated with AKI well.All 27 patients with SAP complicated with AKI survived.Multiple organ dysfunction syndrome?MODS?,acute respiratory distress syndrome?ARDS?were important causes of SAP complicated with AKI death.Conclusion:The etiology of SAP is the most common cholelithiasis.Influencing factors of SAP complicated with AKI were include CRP,ALB,APACHE II score,PO₂ and Ca²⁺,predictive model had higher predictive risk,SAP patients with simple AKI had a better prognosis,therefore,In the early stages of the disease,treatments such as controlling infection and protecting organs were critical to the prognosis of the disease.