Wu W, Zhang YP, Zhang YL, Qu XG, Zhang ZH, Zhang R, Peng ZY. Nonlinear association between estimated plasma volume status and acute kidney injury in acute pancreatitis patients. World J Gastroenterol 2025; 31(20): 105269 [DOI: 10.3748/wjg.v31.i20.105269]
Corresponding Author of This Article
Rong Zhang, MD, Doctor, Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, No. 183 Yiling Avenue, Wujiagang District, Yichang 443000, Hubei Province, China. zhangrong20240304@163.com
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wen Wu, Yu-Pei Zhang, Yi-Lan Zhang, Xing-Guang Qu, Zhao-Hui Zhang, Rong Zhang, Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
Wen Wu, Yu-Pei Zhang, Yi-Lan Zhang, Xing-Guang Qu, Zhao-Hui Zhang, Rong Zhang, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
Wen Wu, Zhi-Yong Peng, Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Wen Wu, Zhi-Yong Peng, Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei Province, China
Co-corresponding authors: Rong Zhang and Zhi-Yong Peng.
Author contributions: Wu W and Zhang YP conceived, designed the study and obtained the data, which was analyzed by Wu W; Zhang YP, Zhang YL, Qing XG and Zhang ZH interpreted the data and results and drafted the manuscript; Zhang R and Peng ZY critically revised the manuscript for intellectual content; All authors were responsible for interpretation of data and for approving the draft manuscript.
Institutional review board statement: The present retrospective study was approved by the Ethics Committee of Yichang Central People’s Hospital, (ethical approval number: 2023-130-01), and performed following Declaration of Helsinki.
Informed consent statement: Informed consent was waived because of the retrospective nature of the study and the analysis used de-identified data.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Data is available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rong Zhang, MD, Doctor, Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, No. 183 Yiling Avenue, Wujiagang District, Yichang 443000, Hubei Province, China. zhangrong20240304@163.com
Received: January 18, 2025 Revised: April 18, 2025 Accepted: May 12, 2025 Published online: May 28, 2025 Processing time: 131 Days and 22.5 Hours
Abstract
BACKGROUND
Acute pancreatitis (AP), a severe pancreatic inflammatory condition, with a mortality rate reaching up to 40%. Recently, AP shows a steadily elevating prevalence, which causes the greater number of hospital admissions, imposing the substantial economic burden. Acute kidney injury (AKI) complicates take up approximately 15% of AP cases, with an associated mortality rate of 74.7%-81%.
AIM
To evaluate the efficacy of estimated plasma volume status (ePVS) in forecasting AKI in patients with AP.
METHODS
In this retrospective cohort study, AP cases were recruited from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023. Electronic medical records were adopted for data extraction, including demographic data and clinical characteristics. The association between ePVS and AKI was analyzed using multivariate logistic regression models, with potential confounders being adjusted. Nonlinear relationship was examined with smooth curve fitting, and infection points were calculated. Further analyses were performed on stratified subgroups and interaction tests were conducted.
RESULTS
Among the 1508 AP patients, 251 (16.6%) developed AKI. ePVS was calculated using Duarte (D-ePVS) and Kaplan-Hakim (KH-ePVS) formulas. After adjusting for covariates, the AKI risk exhibited 46% [odds ratio (OR) = 1.46, 95% confidence interval (CI): 0.96-2.24] and 11% (OR = 1.11, 95%CI: 0.72-1.72) increases in the low tertile (T1) of D-ePVS and KH-ePVS, respectively, and 101% (OR = 2.01, 95%CI: 1.31-3.05) and 51% (OR = 1.51, 95%CI: 1.00-2.29) increases in the high tertile (T3) relative to the reference tertile (T2). Nonlinear curve fitting revealed a U-shaped association of D-ePVS with AKI and a J-shaped association for KH-ePVS, with inflection points at 4.3 dL/g and -2.8%, respectively. Significant interactions were not observed in age, gender, hypertension, diabetes mellitus, sequential organ failure assessment score, or AP severity (all P for interaction > 0.05).
CONCLUSION
Our results indicated that ePVS demonstrated the nonlinear association with AKI incidence in AP patients. A U-shaped curve was observed with an inflection point at 4.3 dL/g for the Duarte formula, and a J-shaped curve at -2.8% for the Kaplan-Hakim formula.
Core Tip: This study is the largest to date examining acute kidney injury (AKI) in patients with acute pancreatitis (AP), and it is the first to explore the association between estimated plasma volume status (ePVS) and the incidence of AKI. The study utilized two formulas (Duarte and Kaplan-Hakim) to assess ePVS and its relationship with AKI risk. Through smooth curve fitting analysis, the results revealed a nonlinear relationship between ePVS and AKI risk, including U-shaped and J-shaped curves. These findings provide important reference for the prediction and management of AKI in patients with AP.
