早期腹内压水平对急性重症胰腺炎患者并发急性肾损伤的预测价值

Predictive value of early phase intra-abdominal pressure for severe acute pan-creatitis complicated with acute kidney injury

摘要:

目的 探讨早期腹内压(IAP)水平对急性重症胰腺炎(SAP)患者并发急性肾损伤(AKI)的预测价值。方法 选取2016年1月至2017年9月由上海市宝山区中西医结合医院急诊科收入重症监护室的SAP患者60例,根据患者入院后72 h 内早期IAP水平,以连续2次IAP水平高于12 mmHg(1 mmHg=0.133 kPa)为标准,将患者分为高腹内压(IAH)组和非高腹内压(non-IAH)组。收集并比较2组患者间一般资料、AKI发生情况及行连续肾脏替代疗法(CRRT)比例差异。采用受试者工作特征(ROC)曲线分析早期IAP水平对SAP患者并发AKI的预测价值。采用SPSS 17.0软件进行统计分析。根据数据类型,组间比较采用t检验或χ²检验。结果 IAH组患者肿瘤坏死因子-ɑ[(2.30±0.79) vs(1.88±0.55)mg/ml,P=0.04]及白细胞介素-6[(217.04±77.16) vs(178.86±60.93)ng/L, P=0.02]水平显著高于non-IAH组,差异有统计学意义。IAH组患者AKI[45.8%(11/24) vs 16.7%(6/36),P=0.02]、行CRRT比例[29.2%(7/24) vs 5.6%(2/36),P=0.02]明显高于non-IAH组。早期IAP水平预测SAP患者并发AKI的ROC曲线下面积为0.728 (OR=4.231,95%CI 1.289～13.889；P<0.05)；早期IAP水平最佳截断点为12 mmHg,灵敏度为82.4%,特异度为34.9%,具有中度准确性。结论 早期IAP水平升高对SAP患者并发AKI具有预测价值,可用于评估SAP患者的AKI发生风险。

Abstract:

Objective To investigate the predictive value of early phase intra-abdominal pressure (IAP) for severe acute pancreatitis (SAP) complicated with acute kidney injury (AKI). Methods A total of 60 SAP patients were enrolled in this study who were treated in the Intensive Care Unit of the Emergency Department in our hospital from January 2016 to September 2017. The patients were divided into intra-abdominal hypertension (IAH) group and non-intra-abdominal hypertension (non-IAH) group, depending on whether 2 consecutive IAP measurements were higher than 12 mmHg (1 mmHg=0.133 kPa) within 72 h after admission. The 2 groups were then compared in the baseline data, incidence of AKI and proportion of continuous renal replacement therapy (CRRT). Receiver operating characteristic (ROC) curve was employed to analyze the predictive value of IAP in the early phase of SAP for AKI. SPSS statistics 17.0 was used for analysis. Student′s t test or Chi-square test was conducted for the comparison according to the data type. Results The IAH group had significantly higher readings than the non-IAH group in tumor necrosis factor-ɑ [(2.30±0.79) vs (1.88±0.55)mg/ml,P=0.04] and interleukin-6 [(217.04±77.16) vs (178.86±60.93)ng/L, P=0.02], and the difference was statistically significant. AKI [45.8%(11/24) vs 16.7%(6/36), P=0.02] and CRRT [29.2%(7/24) vs 5.6%(2/36), P=0.02] were significantly higher in the former than in the latter. The area under ROC curve was 0.728 (OR=4.231,5%CI 1.289-13.889, P<0.05) for IAP in the early phase of SAP in predicting AKI; the cut-off point of the IAP in the early phase of SAP was 12 mmHg with a sensitivity of 82.4% and a specificity of 34.9% and had a moderate accuracy. Conclusion Elevated IAP in the early phase of SAP has predictive value for AKI and can be used to assess the risk of AKI.