The predictive value of systemic immune inflammation index for early acute kidney injury in patients undergoing adult cardiac surgery with cardiopulmonary bypass
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摘要: 目的 探讨全身免疫炎症指数(systemic immune-inflammation index，SII)对成人体外循环心脏术后早期急性肾损伤(acute kidney injury，AKI)的预测价值。方法 回顾性收集2020年1月—2021年12月在南京医科大学第一附属医院接受体外循环成人心脏手术患者的临床资料，按照术后48 h内是否发生AKI，分为AKI组和非AKI组。最终共325例患者纳入本研究，其中术后48 h内发生AKI的患者共63例纳入AKI组，AKI发生率19.4%，其余262例纳入非AKI组。分析比较两组患者的临床资料，采用多元逐步logistic回归分析成人体外循环心脏手术术后发生AKI的独立危险因素，并使用ROC曲线分析SII对术后早期AKI的预测价值。结果 AKI组和非AKI组患者在高血压病史、服用利尿剂、术前SII、血清尿素氮、手术持续时间、估算的肾小球滤过率(estimated glomerular filtration rate，eGFR)、术后机械通气时间、体外循环持续时间、术中失血量和术后24 h尿量等方面比较均差异有统计学意义(均P＜0.05)，多因素logistic分析显示体外循环持续时间、术前SII和eGFR是术后AKI的独立危险因素(P＜0.05)。ROC曲线分析显示，术前SII和eGFR预测术后AKI的AUC分别为0.927(95%CI：1.009~1.041)和0.828(95%CI：0.959~0.998)，对应的灵敏度分别为98.4%和95.2%，特异度分别为77.1%和64.9%。结论 术前SII是成人体外循环心脏外科术后发生AKI的独立危险因素，术前及时评估SII对预测AKI的发生具有非常好的价值。Abstract: Objective To investigate the predictive value of the systemic immune-inflammation index(SII) for early acute kidney injury(AKI) in adult patients after cardiac surgery with cardiopulmonary bypass.Methods Clinical data of adult patients undergoing cardiac surgery with cardiopulmonary bypass in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2021 were retrospectively collected. Patients were grouped into AKI group and non-AKI group according to whether AKI occurred within 48 hours after surgery. Clinical information of the two groups were researched and compared. Multivariate logistic regression was used to analyze independent risk factors for postoperative AKI after cardiopulmonary bypass surgery. Receiver operating characteristic(ROC) curve was used to investigate the value of SII in predicting the occurrence of AKI.Results A total of 325 patients were involved in this research, among which, 63 patients with postoperative AKI within 48 hours were included in the AKI group, with an incidence of 19.4%, and the remaining 262 patients were grouped in the non-AKI group. There were statistical significance in the history of hypertension, the history of taking diuretics, preoperative SII, plasma urea nitrogen, estimated glomerular filtration rate(eGFR), duration of operation, extracorporeal circulation time, intraoperative blood loss, duration of mechanical ventilation time, and postoperative 24-hour urine volume between the two group, there were significantly different in two groups(all P < 0.05). Multiple-factor logistic analysis revealed that extracorporeal circulation time, preoperative SII and eGFR were independent risk factors for postoperative AKI after cardiopulmonary bypass surgery(P < 0.05). ROC curve analysis demonstrated that the AUC of preoperative SII and eGFR in predicting postoperative AKI after cardiopulmonary bypass surgery were 0.927(95%CI: 1.009-1.041), and 0.828(95%CI: 0.959-0.998), the corresponding sensitivity was 98.4% and 95.2% respectively, and the specificity was 77.1% and 64.9%, severally.Conclusion Preoperative SII is an independent risk factor for postoperative AKI after cardiopulmonary bypass surgery and timely assessment of preoperative SII is of great value in predicting the occurrence of AKI in adult patients undergoing cardiac surgery with cardiopulmonary bypass.
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表 1 两组患者临床情况比较
X±S，M(P25，P75) 项目 AKI组(63例) 对照组(262例) 统计值 P 性别/例 2.381 0.123 男 43 151 女 20 111 年龄/岁 61.5±11.2 60.3±10.4 0.82 0.413 机械通气时间/h 6(3，9) 2(1，4) 4388 ＜0.001 吸烟史/例 3.05 0.081 有 20 56 无 43 206 高血压/例 112/150 4.243 0.039 有 36 112 无 27 150 糖尿病/例 3.398 0.065 有 3 34 无 60 228 利尿剂/例 10.323 0.001 有 27 170 无 36 92 收缩压/mmHga) 135.0±22.4 129.7±18.3 1.737 0.086 舒张压/mmHg 75.7±13.9 75.7±13.4 0.018 0.986 术前血红蛋白/(g/L) 134.9±20.3 136.4±15.9 0.511 0.611 术前SII 1 192.5±412.6 405.8±194.3 14.747 ＜0.001 术前尿素氮/(mmol/L) 7.3±2.7 6.5±1.7 2.253 0.027 术前eGFR/(mL/min/1.73 m2) 68.7(54.9，81.8) 205.7(88.3，375.7) 13.874 ＜0.001 手术持续时间/h 6.8±2.2 5.6±1.4 3.994 ＜0.001 体外循环时间/h 3.2±1.1 2.6±0.9 3.718 ＜0.001 术中最大量去甲肾上腺素/(μg/kg/min) 0.02(0.00，0.04) 0.02(0.00，0.06) 8 062 0.807 术中出血量/mL 1 000(800，1 500) 800(600，1 000) 5 945.5 0.001 术后24 h尿量/mL 1 430(535，2 220) 2 317(1 900，2 832) 4 256.5 ＜0.001 a)1 mmHg=0.133 kPa。 
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表 2 多因素logistic回归分析
项目 β SE Wald P OR(95%CI) 术前SII 0.025 0.008 9.221 0.002 1.025(1.009~1.041) 术前eGFR -0.022 0.01 4.761 0.029 0.978(0.959~0.998) 体外循环时间 2.895 1.451 3.982 0.046 18.087(1.053~310.738)
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