Wang Yi, Cao Li-Kun, Wei Yi, Song Bin
From the Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
J Comput Assist Tomogr. 2018 Sep/Oct;42(5):680-687. doi: 10.1097/RCT.0000000000000749.
To retrospectively determine the value of modified renal rim grade (MRRG) in predicting acute kidney injury (AKI) in the early phase of severe acute pancreatitis (SAP).
This institutional review board-approved retrospective study included patients with SAP who underwent abdominal contrast-enhanced computed tomography (CT) within 48 hours after disease onset. Modified renal rim grade, renal rim grade, CT severity index, modified CT severity index, extrapancreatic inflammation on CT scores, and posterior pararenal (PPR) space involvement were assessed. Clinical data, including bedside index of severity in acute pancreatitis and New Japanese Severity Scoring system scores, were collected. Primary end points were AKI and mortality. Scores were evaluated by receiver operating characteristic curve analysis. Correlational analyses between MRRG scores and the other scores were performed with Spearman analysis.
One hundred five consecutive patients were enrolled in our study. The areas under the curve (AUCs) of MRRG in predicting AKI (0.90) and mortality (0.83) were comparable to extrapancreatic inflammation on CT (0.89 and 0.85, P > 0.05) and were higher than those of the other CT scores (P < 0.05). Modified renal rim grade score of greater than 4 yielded sensitivities and specificities of 81% and 89% for predicting AKI and 88% and 66% for mortality. Modified renal rim grade correlated moderately with bedside index of severity in acute pancreatitis (Spearman r = 0.47) and New Japanese Severity Scoring system (r = 0.43) scores. Besides, the prevalence of PPR space involvement in nonrecovery AKI patients was higher than that in recovery patients (94% vs 36%, P < 0.05).
Modified renal rim grade is well correlated with the occurrence of AKI and mortality in SAP. The PPR space involvement is a promising prognostic factor for nonrecovery of AKI in SAP patients.
回顾性确定改良肾周缘分级（MRRG）在预测重症急性胰腺炎（SAP）早期急性肾损伤（AKI）中的价值。
本项经机构审查委员会批准的回顾性研究纳入了发病后48小时内接受腹部增强计算机断层扫描（CT）的SAP患者。评估改良肾周缘分级、肾周缘分级、CT严重程度指数、改良CT严重程度指数、CT评分上的胰腺外炎症以及肾后间隙（PPR）受累情况。收集临床数据，包括急性胰腺炎床边严重程度指数和新日本严重程度评分系统评分。主要终点为AKI和死亡率。通过受试者操作特征曲线分析评估评分。采用Spearman分析进行MRRG评分与其他评分之间的相关性分析。
105例连续患者纳入本研究。MRRG预测AKI（0.90）和死亡率（0.83）的曲线下面积（AUC）与CT上的胰腺外炎症（0.89和0.85，P>0.05）相当，且高于其他CT评分（P<0.05）。改良肾周缘分级评分大于4时，预测AKI的敏感性和特异性分别为81%和89%，预测死亡率的敏感性和特异性分别为88%和66%。改良肾周缘分级与急性胰腺炎床边严重程度指数（Spearman r = 0.47）和新日本严重程度评分系统（r = 0.43）评分中度相关。此外，未恢复的AKI患者中PPR间隙受累的患病率高于恢复患者（94%对36%，P<0.05）。
改良肾周缘分级与SAP中AKI的发生和死亡率密切相关。PPR间隙受累是SAP患者AKI未恢复的一个有前景的预后因素。
