血清降钙素原水平对慢性阻塞性肺疾病急性加重期发生急性肾损伤的预测价值

    Predictive value of serum procalcitonin for acute kidney injury during acute exacerbation of chronic obstructive pulmonary disease

      摘要
    • 摘要: 目的 探讨血清降钙素原水平对慢性阻塞性肺疾病急性加重期发生急性肾损伤（acute kidney injury，AKI）的预测价值。方法 将纳入标准的患者以入院后是否发生AKI分为N-AKI组与AKI组两组，并且作为因变量，各临床资料指标作为自变量，通过Logistic回归估计倾向性评分值，采用倾向性评分匹配1∶1最近邻居匹配法进行匹配，之后再检验两组匹配后组间临床资料的均衡性，t检验比较匹配后两组患者入院时血清降钙素原（procalcitonin，PCT）水平，采用Pearson相关分析肌酐清除率（creatinine clearance rate，Ccr）与相关指标的相关性，采用Logistic回归模型评价配比前后血清PCT水平对慢阻肺急性加重患者入院后发生AKI的影响，绘制血清PCT水平预测慢阻肺急性加重期患者发生AKI的ROC曲线，P<0.05为差异有统计学意义。结果 采用倾向性评分匹配法，两组共62对匹配成功，配比前两组间差异有统计学意义的临床指标经配比后均达到平衡，其他差异无统计学意义的指标均衡性也得到了明显的提高，配比后慢阻肺急性加重期两组血清PCT水平差异有统计学意义，AKI组血清PCT水平显著高于N-AKI组血清PCT水平（2.4±0.5比0.8±0.3，P<0.05），Pearson相关分析显示，Ccr与PaCO2、D-二聚体和PCT呈明显负相关。Cox分析结果显示：入院时血清PCT每上升1 μg/L，慢阻肺急性加重期患者之后发生AKI的风险增加158%（HR：1.58；95%CI：1.15~3.62；P=0.038），以入院时血清PCT值1.7 mg/L作为最佳诊断截点来预测慢阻肺急性加重期患者发生AKI的灵敏度和特异度分别为81.6%和76.5%，AUROC为0.778（95%CI：0.712~0.821）。结论 入院时血清PCT≥1.7 mg/L是慢阻肺急性加重期患者发生AKI的独立预测因素，可作为评估此类患者预后的参考指标之一。

       

      Abstract: Objective To explore the predictive value of serum procalcitonin(PCT)during acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods According to whether acute kidney injury(AKI)occurred after admission,the patients were divided into two groups of N-AKI and AKI.Apart from dependent variables,clinical data parameters were designated as independent variables.Logistic regression was utilized for estimating the propensity score value and propensity score matching 1:1 nearest neighbor matching adopted.Then the balance of clinical data between two groups after matching was tested and serum level of PCT between two groups at admission was compared by t-test.Pearson’s correlation analysis was utilized for examining the correlation between Ccr and related parameters.Logistic regression model was utilized for evaluating the effect of serum PCT level on AKI.And ROC curve of serum level of PCT was plotted for predicting AKI in patients with acute exacerbation of COPD(P<0.05)and the difference was statistically significant.Results With propensity score matching,a total of 62 pairs of matching were successful in two groups.After matching,clinical data parameters with significant inter-group difference reached balance after matching,and the balance of other parameters without significant difference also significantly improved.After matching,serum PCT levels were significantly different between two groups,serum level of PCT was significantly higher in AKI group than that in N-AKI group(2.4±0.5 vs 0.8±0.3,P<0.05).Pearson’s correlation analysis showed that Ccr was significantly negatively correlated with PaCO2,D-dimer and PCT.Cox analysis indicated that with an increment of serum PCT by 1 ng/mL,the risk of AKI after acute exacerbation of COPD increased by 158%(HR:1.58;95% CI:1.15-3.62;P=0.038),the sensitivity and specificity of optimal cut-off value of PCT with 1.7 mg/L at admission predicting AKI in patients with acute exacerbation of COPD were 81.6% and 76.5% respectively and the AUROC was 0.778(95%CI:0.712-0.821).Conclusion Serum PCT≥1.7 mg/L at admission is an independent predictor of AKI during acute exacerbation of COPD patients.It may be used as one of the reference parameters for evaluating patient prognosis.

       

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