血清乳酸脱氢酶水平与住院患者急性肾损伤的相关性研究及预后风险评估

A Study on the Correlation between Serum Lactate Dehydrogenase Level and Acute Kidney Injury in Hospitalised Patients and Prognostic Risk Assessment

摘要: 目的：探讨血清乳酸脱氢酶(LDH)水平与住院患者急性肾损伤(AKI)及死亡风险的相关性，为早期识别AKI提供指导。方法：纳入2023年1月至2023年12月在本院的4909例患者，对患者临床数据进行回顾性收集。根据血清LDH水平的四分位数将患者分为四组(Q1~Q4组)，比较各组患者基线特征，使用logistic回归模型评估不同LDH组与住院患者AKI的相关性，探究LDH水平对AKI患者死亡的影响。进行亚组分析，以确定LDH水平与住院患者发生AKI风险在不同亚组间是否有差异。使用受试者工作特征(ROC)曲线评估LDH的预测效能。结果：4909例患者中有850例发生AKI，占总人群17.32%。AKI发生率随着LDH水平的增加而增加(12.96% vs. 13.45% vs. 18.09% vs. 22.78%)。在未校正的logistic回归分析中，与对照组Q1相比，Q3组(OR 1.49, 95% CI 1.19~1.85, P < 0.01)和Q4组(OR 2.21, 95% CI 1.79~2.74, P < 0.01)发生AKI的风险更高。使用模型1校正混杂因素后，Q3组和Q4组的调整OR (95% CI)分别为1.49 (1.20~1.87)和2.20 (1.78~2.72)。经模型2调整后观察到类似结果，Q3组、Q4组的OR分别为1.44、1.89，95% CI分别为1.19~1.85、1.51~2.38，Q3组P = 0.002，Q4组<0.001。在未调整的logistic回归分析中，与Q1组相比，Q4组(OR 5.07, 95% CI 1.97~13.09, P = 0.001)的AKI患者发生死亡的风险较高。使用模型1校正混杂因素后，Q4组的调整OR (95% CI)为5.30 (2.04~13.77)。经模型2校正后观察到类似结果，Q2组、Q4组的OR分别为3.90、2.97，95% CI分别为1.24~12.24、1.05~8.46。ROC曲线显示LDH对住院患者发生AKI具有预测价值，曲线下面积(AUC)为0.59 (95% CI 0.56~0.62, P < 0.05)。LDH预测AKI患者死亡的AUC为0.70 (95% CI 0.67~0.73, P < 0.05)，当血清LDH水平与血清肌酐(Scr)结合起来预测住院患者AKI风险及AKI患者的住院死亡时，ROC曲线面积分别提高至0.60和0.80。结论：高水平血清LDH与住院期间发生AKI的风险独立相关，且LDH水平越高，AKI患者的死亡率越高。监测住院患者血清LDH水平可为早期识别AKI、改善患者预后提供指导。

Abstract: Objective: To explore the relationship between serum lactate dehydrogenase (LDH) levels and acute kidney injury (AKI) in hospitalized patients to guide the early identification of AKI. Methods: This study included 4909 patients hospitalized in our hospital from January 2023 to December 2023, and patients’ clinical data were retrospectively collected. The study population was divided into four groups (groups Q1~Q4) according to the quartile of serum LDH levels. Differences in baseline characteristics between the 4 groups were compared. Using logistic regression models to evaluate the association of different serum LDH groups with AKI in hospitalized patients and investigating the effect of LDH levels on mortality in patients with AKI. Subgroup analyses were performed to examine differences in the association between LDH levels and the risk of developing AKI in hospitalized patients in different subgroups. ROC curve was used to assess the predictive performance of LDH. Results: AKI occurred in 850 of 4909 patients, representing 17.32% of the total population. AKI incidence increases with increasing LDH levels (12.96% vs. 13.45% vs. 18.09% vs. 22.78%). In unadjusted logistic regression analysis, the risk of AKI was higher in the Q3 (OR 1.49, 95% CI 1.19~1.85, P < 0.01) and Q4 (OR 2.21, 95% CI 1.79~2.74, P < 0.01) groups compared with the control group Q1. After adjustment for confounders using model 1, the adjusted OR (95% CI) was 1.49 (1.20~1.87) and 2.20 (1.78~2.72) for the Q3 and Q4 groups, respectively. Similar results were observed after adjustment using model 2, the ORs of the Q3 and Q4 groups were 1.44 and 1.89, respectively, with 95% CIs of 1.19~1.85 and 1.51~2.38, respectively, and P values of 0.002 and <0.001, respectively). In unadjusted logistic regression analysis, the risk of mortality in AKI patients was higher in the Q4 (OR 5.07, 95% CI 1.97~13.09, P = 0.001) compared with the control group Q1. After adjusting for the confounders using model 1, the adjusted OR (95% CI) was 5.30 (2.04~13.77) for the Q4 group. Similar results were observed after adjustment by model 2, the ORs of the Q2 and Q4 groups were 3.90 and 2.97, respectively, with 95% CIs of 1.24~12.24 and 1.05~8.46, P < 0.05. The ROC curve showed the predictive value of LDH for the development of AKI in hospitalized patients, with an area under the curve of 0.59 (95% CI 0.56~0.62, P < 0.05). The AUC for LDH in predicting death among patients with AKI was 0.70 (95% CI 0.67~0.73, P < 0.05). When serum LDH levels are combined with serum creatinine (Scr) to predict the risk of AKI in hospitalized patients and the in-hospital mortality of AKI patients, the ROC curve areas increase to 0.60 and 0.80, respectively. Conclusion: High serum LDH levels were independently associated with the risk of AKI during hospitalization, and higher LDH levels were associated with higher mortality in patients with AKI. Monitoring the serum LDH level in hospitalized patients can provide guidance for early detection of AKI.