Pleural Effusion Is Associated with Severe Renal Dysfunction in Patients with Acute Pancreatitis.
Pleural Effusion Is Associated with Severe Renal Dysfunction in Patients with Acute Pancreatitis.
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DOI：
10.12659/msm.928118
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发表时间：
2021-03-08
期刊：
影响因子：
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通讯作者：
Zhong HJ
中科院分区：
文献类型：
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作者：
Zeng QX;Jiang KL;Wu ZH;Huang DL;Huang YS;Zhuang HW;Zhong HJ
肾功能不全是急性胰腺炎（AP）患者死亡的主要原因，通常发生在呼吸系统并发症之后。呼吸系统并发症是否可以预测肾损害仍不清楚。本研究的目的是探讨急性胰腺炎胸腔积液与肾功能不全之间的关系。对2015年1月1日至2019年12月31日期间因AP住院的个人的医疗记录进行了审查。根据入院时是否存在胸腔积液，将患者分为2组。比较两组间的疾病严重程度、肾功能参数和结局。共有222名患者入组，其中25名患者入院时有胸腔积液，197名患者没有胸腔积液。有胸腔积液的AP患者病情更严重（胰腺炎症、胰腺积液和中重度AP的发生率更高;急性胰腺炎严重程度床边指数评分更差;改良计算机断层扫描严重程度指数更高[均P<0.05]），预后更差（通气和血管加压药使用率更高[均P<0.05]）。有胸腔积液者血尿素氮水平明显高于无胸腔积液者，肾小球滤过率明显低于无胸腔积液者（P均<0.05）。校正潜在混杂因素后，胸腔积液是AP患者肾衰竭的危险因素（比值比6.32，95%置信区间1.08-36.78，P=0.040）。胸腔积液与AP的严重肾功能不全相关。因此，应努力提高早期识别和及时治疗肾功能衰竭的AP和胸腔积液患者入院时密切监测肾功能。
Renal dysfunction is a leading cause of death in patients with acute pancreatitis (AP) and often occurs later than respiratory complications. Whether respiratory complications can predict renal impairment remains unclear. The aim of this study was to investigate the association between pleural effusion and renal dysfunction in AP. Medical records were reviewed from individuals who were hospitalized with AP from January 1, 2015 to December 31, 2019. The patients were divided into 2 groups, based on the presence or absence of pleural effusion on admission. Disease severity, renal function parameters, and outcomes were compared between the 2 groups. A total of 222 patients were enrolled, 25 of whom had pleural effusion on admission and 197 who did not. Patients with AP who had pleural effusion had more serious illness (higher incidences of pancreatic inflammation, pancreatic fluid collection, and moderate-to-severe AP; worse Bedside Index for Severity in Acute Pancreatitis score; and a higher modified computed tomography severity index [all P<0.05]) plus worse outcomes (higher incidences of ventilation and vasopressor use [both P<0.05]). Moreover, patients with pleural effusion had a higher level of blood urea nitrogen and lower estimated glomerular filtration rate (both P<0.05). After adjustment for potential confounders, pleural effusion was a risk factor for renal failure in patients with AP (odds ratio 6.32, 95% confidence interval 1.08–36.78, P=0.040). Pleural effusion is associated with severe renal dysfunction in AP. Therefore, efforts should be made to improve early recognition and timely treatment of renal failure by closely monitoring renal function in patients with AP and pleural effusion on admission.