CTSI联合乳酸在重症急性胰腺炎合并急性肾损伤的预测作用

doi:10.3969/j.issn.1007-3205.2025.01.014

河北医科大学学报 ›› 2025, Vol. 46 ›› Issue (1): 80-85.doi: 10.3969/j.issn.1007-3205.2025.01.014

CTSI联合乳酸在重症急性胰腺炎合并急性肾损伤的预测作用

哈尔滨医科大学附属第一医院重症医学科，黑龙江哈尔滨 150000

出版日期:2025-01-25 发布日期:2025-01-22
作者简介:赵小娟（1990-），女，山东泰安人，哈尔滨医科大学附属第一医院主管护师，医学学士，从事重症医学科疾病管理研究。
基金资助:
黑龙江省自然科学基金（H2021035）

Clinical predictive value of CTSI score combined with lactate in predicting for severe acute pancreatitis complicated with acute kidney injury in severe acute pancreatitis

Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150000, China

Online:2025-01-25 Published:2025-01-22

摘要/Abstract

摘要： 目的评估CT严重指数(CT severity index,CTSI)联合乳酸预测老年重症急性胰腺炎（severe acute pancreatitis,SAP）患者住院期间并发急性肾损伤（acute kidney injury,AKI）的临床价值。
方法回顾性纳入哈尔滨医科大学附属第一医院住院治疗的老年SAP患者328例，根据住院期间是否发生AKI，将其分为AKI组68例（20.73%），非AKI组260例（79.07%）。通过住院患者病历系统收集所有患者的临床资料，采用多因素Logistic回归分析筛选SAP患者住院期间并发AKI的危险因素，并采用ROC曲线评估CTSI、乳酸预测AKI发生的临床效能。
结果单因素分析显示，AKI组年龄＞70岁、糖尿病、病死率、连续性肾脏替代治疗比例以及白细胞介素6、乳酸、CTSI、序贯器官衰竭估计评分、急性生理学及慢性健康状况Ⅱ评分、Charlson合并症指数均高于非AKI组，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，年龄＞70岁(OR=1.267,95%CI:1.042~1.541)、CTSI(OR=1.632,95%CI:1.291~2.064)、乳酸(OR=1.428,95%CI:1.133~1.798)是SAP患者住院期间合并AKI的独立危险因素。ROC曲线显示，CTSI联合乳酸预测SAP患者住院期间合并AKI的AUC［0.869(95%CI:0.818~0.920)］高于单一CTSI［AUC:0.733(95%CI:0.664~0.802)］、乳酸［AUC:0.695(95%CI:0.624~0.766)］，预测性能最优。
结论 CTSI及乳酸是SAP患者住院期间合并AKI的独立危险因素，联合检测可预测AKI的发生风险，进而辅助临床筛选出高危人群，以便针对性干预。

关键词: 胰腺炎, 急性肾损伤, CT严重指数, 乳酸

Abstract: Objective To assess the clinical value of CT severity index (CTSI) combined with lactate in predicting acute kidney injury (AKI) in elderly patients with severe acute pancreatitis (SAP)during hospitalization.
Methods A total of 328 elderly SAP patients hospitalized in the First Hospital of Harbin Medical University were retrospectively included, and were divided into the AKI group (n=68, 20.73%)and the non-AKI group (n=260, 79.07%) according to whether AKI occurred during hospitalization. The clinical data of all patients were collected through the inpatient medical record system. Multivariate Logistic regression analysis was used to screen the risk factors for AKI during hospitalization in SAP patients, and receiver operating characteristic (ROC) curve was used to assess the clinical efficacy of CTSI and lactate in predicting the occurrence of AKI.
Results Univariate analysis showed that age ＞70 years, diabetes mellitus, morbidity and mortality, proportion of consecutive renal replacement therapy, and interleukin 6, lactate, CTSI, sequential organ failure estimation score, acute physiology and chronic health evaluation Ⅱ scores, and Charlson comorbidity index were higher in AKI group than in the non-AKI group, showing significant difference (P＜0.05). The results of multivariate Logistic regression analysis showed that age ＞70 years (OR=1.267, 95%CI: 1.042-1.541), CTSI (OR=1.632, 95%CI: 1.291-2.064), and lactate (OR=1.428, 95%CI: 1.133-1.798) were risk factors for AKI in SAP patients during hospitalization. The ROC curve showed that the area under the ROC curve (AUC) of CTSI combined with lactate in patients with SAP complicated with AKI was ［0.869 (95%CI: 0.818-0.920)］, which was higher than that predicted by CTSI ［0.733 (95%CI: 0.664-0.802)］, and orlactate ［0.695 (95%CI: 0.624-0.766)］ alone, showing optimal predictive performance.
Conclusion CTSI and lactate are independent risk factors for AKI during hospitalization in SAP patients, and the combined detection can predict the risk of AKI, and then assist in clinical practice to screen out the high-risk group for targeted intervention.

Key words: pancreatitis, acute kidney injury, CT severity index, lactate

赵小娟, 李欣欣. CTSI联合乳酸在重症急性胰腺炎合并急性肾损伤的预测作用 [J]. 河北医科大学学报, 2025, 46(1): 80-85.

ZHAO Xiao-juan, LI Xin-xin. Clinical predictive value of CTSI score combined with lactate in predicting for severe acute pancreatitis complicated with acute kidney injury in severe acute pancreatitis [J]. Journal of Hebei Medical University, 2025, 46(1): 80-85.

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CTSI联合乳酸在重症急性胰腺炎合并急性肾损伤的预测作用

Clinical predictive value of CTSI score combined with lactate in predicting for severe acute pancreatitis complicated with acute kidney injury in severe acute pancreatitis

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