Establishment and clinical application evaluation of early warning model for acute pancreatitis complicated with AKI

doi:10.3969/j.issn.1673-8640.2025.08.009

Abstract

Abstract:

Objective To establish an early warning model for acute pancreatitis（AP） complicated with acute kidney injury（AKI） based on clinical data and AKI biomarkers，and to validate and evaluate its clinical efficacy. Methods A total of 100 patients with AP in Qingdao Jiaozhou Central Hospital from January 2021 to December 2023 were enrolled as training set and classified into AKI group（41 cases） and non-AKI group（59 cases） based on whether they were complicated with AKI. All the clinical data were collected，and the biomarkers of AKI [urinary cystatin C（Cys C），urinary kidney injury molecule-1（KIM-1），serum creatinine（SCr），serum liver-type fatty acid binding protein（L-FABP） and serum interleukin-18（IL-18）] were determined. Totally，30 patients with AP in Qingdao Jiaozhou Central Hospital from January to December 2024 were enrolled as external training set. Random forest-Logistic regression analysis was used to evaluate the influencing factors of AP complicated with AKI，and an early warning nomogram model was constructed. The clinical application value of the nomogram model was evaluated by receiver operating characteristic（ROC） curve，calibration curve，decision curve analysis and clinical impact curve. Results The proportion of patients using vasoactive drugs and mechanical ventilation，acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score，sequential organ failure assessment（SOFA） score，urinary Cys C，urinary KIM-1，serum L-FABP and serum IL-18 in AKI group were all higher than those in non-AKI group（P<0.05）. The top 6 important variables were serum L-FABP，urinary Cys C，urinary KIM-1，serum IL-18，SOFA score and APACHE Ⅱ score. Serum L-FABP，urinary Cys C，urinary KIM-1，serum IL-18，SOFA score and APACHE Ⅱ score were all risk factors for AP complicated with AKI（P<0.05）. A nomogram model for predicting AKI in AP patients was established based on the results of Logistic regression analysis. The area under curve（AUC） of the nomogram model was 0.884，the predicted value was consistent with the actual incidence rate（Brier value was 0.107，calibration was 0.811）. When the threshold probability value was 25% to 75%，the nomogram model had obvious positive net benefit，and the maximum net benefit was 0.4. There was no statistical significance between the model-predicted values and the actual observed values（χ²=2.516，P=0.842）. Conclusions The nomogram model for early warning of AP complicated with AKI established based on serum L-FABP，urinary Cys C，urinary KIM-1，serum IL-18，SOFA score and APACHE Ⅱ score has good clinical applicability and can provide a reference for the risk assessment of AP complicated with AKI.

Key words: Acute kidney injury, Biomarker, Acute pancreatitis, Nomogram model

CLC Number:

R692

GAO Xiantong, YAO Qianqian, RU Lijuan. Establishment and clinical application evaluation of early warning model for acute pancreatitis complicated with AKI[J]. Laboratory Medicine, 2025, 40(8): 775-781.

Figures/Tables 11

References 27

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组别	例数			年龄/岁			性别					体重指数/（kg·m^-2）		饮酒史/ [例（%）]			吸烟史/ [例（%）]			糖尿病史/[例（%）]
组别	例数			年龄/岁			男/[例（%）]			女/[例（%）]		体重指数/（kg·m^-2）		饮酒史/ [例（%）]			吸烟史/ [例（%）]			糖尿病史/[例（%）]
AKI组	41			51.00±7.84			27（65.85）			14（34.15）		24.25±0.52		8（19.51）			24（58.54）			9（21.95）
无AKI组	59			49.52±6.33			35（59.32）			24（40.68）		24.09±0.64		7（11.86）			28（47.46）			8（13.56）
统计值				1.042			0.438					1.325		1.110			1.190			1.207
P值				0.309			0.508					0.188		0.292			0.275			0.272
组别		冠心病史/ [例（%）]			高血压史/ [例（%）]			高脂血症史/[例（%）]				病因							心率/（次·min^-1）
组别		冠心病史/ [例（%）]			高血压史/ [例（%）]			高脂血症史/[例（%）]				暴饮暴食/ [例（%）]		过度饮酒/ [例（%）]		胆源性/ [例（%）]			心率/（次·min^-1）
AKI组		5（12.20）			7（17.07）			15（36.59）				6（14.63）		10（24.39）		25（60.98）			102.25±9.46
无AKI组		4（6.78）			12（20.34）			16（27.12）				11（18.64）		15（25.42）		33（55.93）			104.00±11.18
统计值		0.866			0.168			1.014				0.500							-0.819
P值		0.352			0.682			0.314				0.617							0.415
组别			收缩压/Kpa			舒张压/Kpa			APACHE Ⅱ 评分/分		SOFA评分/分		应用血管活性药物/[例（%）]		机械通气/ [例（%）]			肝功能障碍/[例（%）]
AKI组			16.81±0.91			11.04±0.72			21.59±4.77		5.47±0.41		17（41.46）		11（26.83）			5（12.20）
无AKI组			16.62±1.01			10.96±0.84			15.00±3.68		3.12±0.50		9（15.26）		4（6.78）			5（8.47）
统计值			0.963			0.496			7.792		24.836		8.636		7.627			0.372
P值			0.338			0.621			<0.001		<0.001		0.003		0.006			0.542

组别	例数			年龄/岁			性别					体重指数/（kg·m^-2）		饮酒史/ [例（%）]			吸烟史/ [例（%）]			糖尿病史/[例（%）]
组别	例数			年龄/岁			男/[例（%）]			女/[例（%）]		体重指数/（kg·m^-2）		饮酒史/ [例（%）]			吸烟史/ [例（%）]			糖尿病史/[例（%）]
AKI组	41			51.00±7.84			27（65.85）			14（34.15）		24.25±0.52		8（19.51）			24（58.54）			9（21.95）
无AKI组	59			49.52±6.33			35（59.32）			24（40.68）		24.09±0.64		7（11.86）			28（47.46）			8（13.56）
统计值				1.042			0.438					1.325		1.110			1.190			1.207
P值				0.309			0.508					0.188		0.292			0.275			0.272
组别		冠心病史/ [例（%）]			高血压史/ [例（%）]			高脂血症史/[例（%）]				病因							心率/（次·min^-1）
组别		冠心病史/ [例（%）]			高血压史/ [例（%）]			高脂血症史/[例（%）]				暴饮暴食/ [例（%）]		过度饮酒/ [例（%）]		胆源性/ [例（%）]			心率/（次·min^-1）
AKI组		5（12.20）			7（17.07）			15（36.59）				6（14.63）		10（24.39）		25（60.98）			102.25±9.46
无AKI组		4（6.78）			12（20.34）			16（27.12）				11（18.64）		15（25.42）		33（55.93）			104.00±11.18
统计值		0.866			0.168			1.014				0.500							-0.819
P值		0.352			0.682			0.314				0.617							0.415
组别			收缩压/Kpa			舒张压/Kpa			APACHE Ⅱ 评分/分		SOFA评分/分		应用血管活性药物/[例（%）]		机械通气/ [例（%）]			肝功能障碍/[例（%）]
AKI组			16.81±0.91			11.04±0.72			21.59±4.77		5.47±0.41		17（41.46）		11（26.83）			5（12.20）
无AKI组			16.62±1.01			10.96±0.84			15.00±3.68		3.12±0.50		9（15.26）		4（6.78）			5（8.47）
统计值			0.963			0.496			7.792		24.836		8.636		7.627			0.372
P值			0.338			0.621			<0.001		<0.001		0.003		0.006			0.542

组别	例数	SCr/（μmol·L^-1）	L-FABP/（μg·L^-1）	KIM-1/（ng·L^-1）	Cys C/（μg·L^-1）	IL-18/（pg·mL^-1）
AKI组	41	69.00±22.75	15.97±5.24	50.21±15.75	70.88±23.59	142.82±42.33
无AKI组	59	65.88±11.49	10.02±3.31	38.66±12.29	54.96±18.27	109.82±36.14
t值		0.902	6.958	4.114	3.799	4.185
P值		0.369	<0.001	<0.001	<0.001	<0.001

组别	例数	SCr/（μmol·L^-1）	L-FABP/（μg·L^-1）	KIM-1/（ng·L^-1）	Cys C/（μg·L^-1）	IL-18/（pg·mL^-1）
AKI组	41	69.00±22.75	15.97±5.24	50.21±15.75	70.88±23.59	142.82±42.33
无AKI组	59	65.88±11.49	10.02±3.31	38.66±12.29	54.96±18.27	109.82±36.14
t值		0.902	6.958	4.114	3.799	4.185
P值		0.369	<0.001	<0.001	<0.001	<0.001

项目	β值	标准误	Wald值	OR^①值（95%CI^②）	P值
APACHE Ⅱ评分	0.353	0.104	11.535	1.424（1.020~1.987）	<0.001
SOFA评分	0.519	0.182	8.128	1.680（1.165~2.423）	0.006
血清L-FABP	0.462	0.125	13.670	1.588（1.436~1.755）	<0.001
尿KIM-1	0.382	0.127	9.055	1.465（1.004~2.139）	<0.001
尿Cys C	0.354	0.133	7.088	1.425（1.215~1.671）	0.019
血清IL-18	0.225	0.096	5.480	1.252（1.118~1.402）	0.035