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| 老年营养风险指数联合中性粒细胞/淋巴细胞比值对术后急性肾损伤的预测价值 |
| Predictive value of geriatric nutritional risk index combined with neutrophil/lymphocyte ratio for postoperative acute kidney injury |
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| DOI：10.12089/jca.2023.09.004 |
| 中文关键词: 老年 结直肠癌根治术 术后急性肾损伤 老年营养风险指数 中性粒细胞/淋巴细胞比值 预测 |
| 英文关键词: Aged Radical resection of colorectal cancer Postoperative acute renal injury Geriatric nutritional risk index Neutrophil/lymphocyte ratio Prediction |
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| 中文摘要: |
目的 探讨老年营养风险指数（GNRI）联合中性粒细胞/淋巴细胞比值（NLR）对老年患者结直肠癌根治术后急性肾损伤（AKI）的预测价值。
方法 选择择期全麻下行结直肠癌根治术老年患者670例，男375例，女295例，年龄≥65岁，BMI 16～35 kg/m2，ASA Ⅰ—Ⅲ级。收集患者临床资料，根据术后7 d内是否发生AKI将患者分为两组：AKI组和非AKI组。采用单因素分析和多因素Logistic回归分析确定老年患者结直肠癌根治术后AKI的独立危险因素。绘制受试者工作特征（ROC）曲线，并通过ROC曲线下面积（AUC）评价术前NLR、术前GNRI及联合检测对老年患者结直肠癌根治术后AKI的预测价值。采用决策曲线分析法（DCA）确定术前NLR、术前GNRI及联合检测时预测老年患者结直肠癌根治术后AKI的临床实用性。
结果 有89例（13.3%）患者发生术后AKI。单因素分析显示：与非AKI组比较，AKI组年龄≥75岁、合并糖尿病、使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、术前NLR、手术时间≥3 h、术中低血压及术中输红细胞比例明显升高（P＜0.05），BMI≥28 kg/m2比例及术前GNRI明显降低（P＜0.05）。多因素Logistic回归分析显示：合并糖尿病（OR=2.140，95％CI 1.125～4.070，P=0.020）、术前NLR值升高（OR=1.608，95％CI 1.414～1.830，P＜0.001）和术中低血压（OR=2.326，95％CI 1.106～4.892，P=0.026）为老年患者结直肠癌根治术后AKI的独立危险因素，术前GNRI值升高（OR=0.868，95％CI 0.838～0.899，P＜0.001）为保护因素。术前NLR、术前GNRI及联合检测预测老年患者结直肠癌根治术后AKI的AUC分别为0.713（95％CI 0.677～0.747）、0.774（95％CI 0.741～0.805）和0.850（95％CI 0.820～0.876）。DCA曲线分析显示，当阈值为0.10～0.95时，术前GNRI联合术前NLR预测老年患者结直肠癌根治术后AKI的净获益率优于术前NLR或GNRI的单独预测。
结论 术前NLR和术前GNRI可用于预测老年患者结直肠癌根治术后AKI的发生风险，且二者联合预测老年患者结直肠癌根治术后AKI风险的效能和净获益率更高。 |
| 英文摘要: |
Objective To investigate the predictive value of geriatric nutritional risk index (GNRI) combined with neutrophil/lymphocyte ratio (NLR) for postoperative acute renal injury (AKI) in elderly patients undergoing radical resection of colorectal cancer.
Methods A total of 670 elderly patients undergoing radical resection of colorectal cancer under general anesthesia were selected, 375 males and 295 females, aged ≥ 65 years, BMI 16-35 kg/m2, ASA physical status Ⅰ-Ⅲ. The patients were divided into two groups according to whether AKI occurred within 7 days after surgery: AKI group and non-AKI group. The clinical data of patients in the two groups was collected, and the independent risk factors of postoperative AKI in elderly patients undergoing radical resection of colorectal cancer were identified by univariate analysis and multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC) was used to evaluate the predictive value of preoperative NLR, preoperative GNRI and combined detection for postoperative AKI in elderly patients undergoing radical resection of colorectal cancer. And decision curve analysis (DCA) was used to determine the clinical practicability of preoperative NLR, preoperative GNRI and combined detection for postoperative AKI in elderly patients undergoing radical resection of colorectal cancer.
Results Eighty-nine patients (13.3%) developed postoperative AKI. The univariate analysis showed that compared with the non-AKI group, the proportion of age ≥ 75 years, diabetes mellitus, angiotensin converting enzyme-inhibitor/angiotensin receptor blockers use, the value of preoperative NLR, operation time ≥ 3 hours, intraoperative hypotension, and intraoperative red blood cell transfusion in the AKI group were significantly increased (P < 0.05), and the proportion of BMI ≥ 28 kg/m2 and the value of preoperative GNRI were significantly decreased (P < 0.05). Multivariate logistic regression analysis showed that diabetes mellitus (OR = 2.140, 95% CI 1.125-4.070, P = 0.020), the elevated value of preoperative NLR (OR = 1.608, 95% CI 1.414-1.830, P < 0.001), and intraoperative hypotension (OR = 2.326, 95% CI 1.106-4.892, P = 0.026) were independent risk factors for postoperative AKI in elderly patients undergoing radical resection of colorectal cancer, and elevated value of preoperative GNRI (OR = 0.868, 95% CI 0.838-0.899, P < 0.001) was protective factor. The AUC of preoperative NLR, preoperative GNRI, and combined detection to predict postoperative AKI in elderly patients undergoing radical resection of colorectal cancer were 0.713 (95% CI 0.677-0.747), 0.774 (95% CI 0.741-0.805), and 0.850 (95% CI 0.820-0.876), respectively. The AUC of preoperative NLR combined with preoperative GNRI to predict postoperative AKI in elderly patients undergoing radical resection of colorectal cancer was significantly greater than that of single detection (P < 0.001). DCA curve analysis showed that when the threshold was 0.10-0.95, the net benefit rate of preoperative NLR combined with preoperative GNRI in predicting postoperative AKI in elderly patients undergoing radical resection of colorectal cancer was better than that of preoperative NLR alone or preoperative GNRI alone.
Conclusion Preoperative NLR and preoperative GNRI can be used to predict the risk of postoperative AKI in elderly patients undergoing radical resection of colorectal cancer, and the combined detection of the both predicting the risk of postoperative AKI in elderly patients undergoing radical resection of colorectal cancer has higher efficiency and net benefit rate. |
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