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    SII、NLR、肌酐和CRP对新冠肺炎患者并发AKI的预测价值

    Predictive value of SII, NLR,creatinine and CRP on COVID-19 patients with AKI

      摘要
    • 摘要: 目的 评估全身免疫炎症指数(SII)、中性粒细胞计数与淋巴细胞计数比值(NLR)、肌酐和C反应蛋白(CRP)对新型冠状病毒肺炎(简称新冠肺炎)患者合并急性肾损伤(AKI)的预测价值。方法 选取2020年1月20日—2020年3月1日于江苏省新冠肺炎疫情定点医院确诊的新冠肺炎患者。根据肾脏损伤情况,将上述患者分为AKI组和非AKI组。比较2组患者的一般资料、临床特征和实验室检查结果。采用二元 Logistic 回归分析筛选新冠肺炎患者并发AKI的危险因素,绘制ROC曲线计算曲线下面积(AUC),评估预测价值。结果 本研究共纳入新冠肺炎患者303例。单因素分析显示,2组在年龄、严重程度、发生呼吸衰竭、入住ICU、合并高血压、合并糖尿病、发生呼吸困难、白细胞计数、中性粒细胞计数、SII、NLR、乳酸脱氢酶、总胆红素、白蛋白、血糖、尿素、肌酐、尿酸、钙离子、氯离子、D-二聚体、CRP等方面比较,差异有统计学意义(P<0.05)。二元Logistic回归分析显示,SII、NLR、肌酐、CRP是新冠肺炎患者发生AKI的独立危险因素。ROC 曲线显示,SII、NLR、肌酐、CRP预测新冠肺炎患者并发AKI的ROC曲线AUC值依次为 0.630(95%CI:0.517~0.744)、0.651(95%CI: 0.528~0.773)、0.943(95%CI: 0.913~0.973)、0.721(95%CI: 0.607~0.834);最佳临界值分别为277.44、3.89、87.70 μmol/L和13.37 g/L;灵敏度依次为 100.0%、45.8%、100.0%、66.7%,特异度依次为 26.2%、82.1%、79.9%、66.7%。结论 SII、NLR、肌酐、CRP是新冠肺炎患者发生AKI的独立危险因素,对新冠肺炎患者并发AKI具有较高的预测价值。

       

      Abstract: Objective To explore the predictive values of systemic immune inflammatory index (SII), neutrophil and lymphocyte count ratio (NLR), creatinine and C-reactive protein (CRP) on corona virus disease 2019 (COVID-19) patients with acute kidney injury (AKI). Methods Patients who were diagnosed with COVID-19 in the COVID-19 epidemic hospitals of Jiangsu Province from January 20, 2020 to March 1, 2020 were enrolled. According to the presence of renal injury, the patients were divided into two groups: an AKI group and a non-AKI group. Both groups were compared for general information, clinical characteristics and laboratory examination results. Multivariate logistic regression analysis was used to screen the risk factors of AKI in COVID-19 patients. A ROC curve was plotted to calculate AUC and evaluate prognostic values. Results A total of 303 patients were enrolled in the current study. According to univariate analysis, there were statistical differences between the two groups in age, severity, respiratory failure, ICU admission, hypertension, diabetes mellitus, dyspnea, leukocyte count, neutrophil count, SII, NLR, lactate dehydrogenase, total bilirubin, albumin, glucose, urea, creatinine, uric acid, calcium ion, chloride ion, D-dimer, and C-reactive protein (CRP) (P<0.05). Binary Logistic regression analysis showed that SII, NLR, creatinine and CRP were the independent risk factors for AKI in COVID-19 patients.The ROC curve showed that the AUC of SII, NLR, creatinine and CRP were 0.630 (95% CI: 0.517—0.744), 0.651 (95% CI: 0.528—0.773), 0.943 (95% CI: 0.913-0.973) and 0.721 (95% CI: 0.607—0.834), respectively. The optimal cut-off values were 277.44, 3.89, 87.70 μmol/L and 13.37 g/L, respectively. The sensitivity was 100.0%, 45.8%, 100.0% and 66.7%, and the specificity was 26.2%, 82.1%, 79.9% and 66.7%, respectively. Conclusions SII, NLR, creatinine and CRP are the independent risk factors for AKI in patients with COVID-19. They are of good value in predicting the renal function injury and evaluating the prognosis in patients with COVID-19.

       

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