Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Emergency, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Curr Med Res Opin. 2022 Apr;38(4):535-540. doi: 10.1080/03007995.2022.2038486. Epub 2022 Feb 27.
Persistent renal failure (PRF) increases morbidity and mortality in acute pancreatitis (AP). Traditional scoring systems achieve good diagnostic value of AP but not PRF alone. Our study aimed to determine PRF predictors in AP patients for early intervention in the disease development.
In the prospective observational study, we consecutively recruited AP patients from October 2013 to October 2016. Complete clinical characteristics on admission were collected. The 2012 revision of the Atlanta classification diagnosed AP, and the Modified Marshall scoring system defined organ failures. We used univariate and multivariate analyses to select risk factors, and plotted survival curves of different groups and ROC curves of parameters to analyze PRF predictors in AP.
A total of 29 AP patients with PRF and 280 AP patients without PRF were included. Severity scoring and ICU admission rate were higher in the former group. The PRF group's mortality was 10-fold higher than without PRF (20.7% versus 2.1%, < .001). Most relevant kidney metabolism indicators and excretion have significant differences ( < .05) between the two groups. Serum calcium (Ca) and pH value (pH) were independent risk factors of PRF ( < .05). ROC curve analysis indicated Ca and pH might predict PRF in AP with areas under the curves (AUCs) of 0.758 and 0.809.
AP patients with PRF had higher morbidity and mortality rate. Our study showed that Ca < 1.94 mmol/L and pH < 7.37 when patients on admission could be used to predict PRF in AP.
持续性肾功能衰竭（PRF）会增加急性胰腺炎（AP）的发病率和死亡率。传统的评分系统对 AP 具有良好的诊断价值，但不能单独预测 PRF。本研究旨在确定 AP 患者发生 PRF 的预测因素，以便对疾病进展进行早期干预。
本前瞻性观察性研究连续纳入 2013 年 10 月至 2016 年 10 月期间的 AP 患者。入院时采集完整的临床特征。采用 2012 年亚特兰大分类标准诊断 AP，改良 Marshall 评分系统定义器官衰竭。我们使用单因素和多因素分析来选择风险因素，并绘制不同组的生存曲线和参数的 ROC 曲线，以分析 AP 中 PRF 的预测因素。
共纳入 29 例 PRF 患者和 280 例非 PRF 患者。前者的严重程度评分和 ICU 入院率更高。PRF 组的死亡率是无 PRF 组的 10 倍（20.7%比 2.1%， < 0.001）。两组间大多数相关肾脏代谢指标和排泄均有显著差异（ < 0.05）。血清钙（Ca）和 pH 值（pH）是 PRF 的独立危险因素（ < 0.05）。ROC 曲线分析表明，Ca 和 pH 值对 AP 中 PRF 的预测具有曲线下面积（AUC）为 0.758 和 0.809。
PRF 的 AP 患者发病率和死亡率更高。本研究表明，入院时 Ca < 1.94 mmol/L 和 pH < 7.37 可用于预测 AP 中的 PRF。
