Acute pancreatitis (AP) is the most common pancreatic disease. Predicting the severity of AP is critical for making preventive decisions. However, the performance of existing scoring systems in pre...

We investigated the value of the serum cystatin C level as a potential predictor of acute kidney injury (AKI) in patients with acute pancreatitis (AP). We retrospectively examined patients diagnosed with AP between January 2013 and December 2018. Patients were categorized into two groups based on their serum cystatin C levels after admission: the normal (n-Cys C group) and high serum cystatin C levels groups (h-Cys C group). Patients in the h-Cys C group demonstrated serum cystatin C levels ≥1.05 mg/L. Demographic parameters, laboratory data, and AP severity were compared between the two groups. Receiver operating curve (ROC) analysis was used to evaluate the efficacy of serum cystatin C in predicting persistent AKI. A total of 379 patients with AP were enrolled: 319 in the n-Cys C group and 60 in the h-Cys C group. Serum cystatin C levels were significantly higher in patients with severe acute pancreatitis (SAP) compared to moderate acute pancreatitis (MAP) (P< 0.05). The h-Cys C group had a higher BISAP score (P < 0.001). Incidences of organ failure and SAP were significantly higher in the h-Cys C group (P < 0.05). ROC analysis indicated that a serum cystatin C cutoff point of 1.055 mg/L optimally predicted persistent AKI (AUC = 0.711). For internal validation, we selected 545 AP patients, treated at our center from 2019 to 2022, including 54 AKI patients. ROC analysis in this validation group yielded a sensitivity of 100% and specificity of 90.9% (AUC = 0.916, 95% CI: 0.894-0.937). Elevated serum cystatin C levels are sensitive indicators of adverse AKI prognosis in AP patients. The cystatin C level at admission can reflect a patient's initial renal function status.

Background. Sexual dimorphism with critical diseases has been documented. However, the role of serum sex hormones for the presence of acute kidney injury (AKI) in moderately or severe acute pancreatitis (MSAP and SAP) patients remains controversial. Here we set out to evaluate whether early (first 48 h) serum estradiol level is associated with AKI in patients with MSAP and SAP. Patients and Methods. We retrospectively collected data from patients with preliminary diagnosis of MSAP and SAP from the Affiliated Hospital of Yangzhou University between January 2014 and June 2018. Serum sex hormones were extracted for further assessment within first 48 h following admission. Logistic regression analysis and the receiving operating characteristic (ROC) curve were applied to evaluate the association and correlation between serum sex hormones and AKI. Results. Data from a total of 122 patients with MSAP or SAP were enrolled in this study. There were no differences in the incidence of AKI between males and females. However, comparing with patients without AKI, those with AKI saw higher estradiol level ( ) and slight higher progesterone level ( ) but similar testosterone level ( ). Interestingly, during both the manual selection and the stepwise backward logistic regression analysis, serum estradiol level was independently associated with AKI in patients with MSAP and SAP (OR 4.699, CI 1.783-12.386, and ). Additionally, area under the curve of ROC (AUCROC) showed that serum estradiol level was a proper predictor for AKI (area under the curve 0.875). Specifically, the serum estradiol level of 223.15 pg/mL demonstrated a 92.3% sensitive and a 79.3% specificity in predicting AKI of MSAP and SAP patients, respectively. Conclusions. High baseline serum estradiol level appears to be an independent risk factor for AKI in patients with MSAP and SAP. It also tends to be an appropriate indicator for AKI.

Background: Patients admitted to the intensive care unit (ICU) have a high risk of refeeding syndrome (RFS). Identifying RFS in its early stages is often challenging, making preventive interventions for high‐risk patients difficult. The aim of this review is to identify risk factors for RFS in ICU patients receiving nutritional support. Study Design: We systematically searched CNKI, Wanfang, VIP, PubMed, Cochrane, Embase, and Web of Science up to November 2024 for cohort/case–control studies assessing RFS risk factors in adults (≥ 18 years). Risk of bias was evaluated using Risk Of Bias In Non‐randomized Studies of Interventions (ROBINS‐I). Data were analyzed using RevMan 5.4. Results: Eighteen articles were included, comprising 3360 cases. Baseline serum phosphate [weighted mean difference (WMD) = −0.10, 95% confidence interval (95% CI) (−0.19∼−0.01)], magnesium [WMD = −0.01, 95% CI (−0.04–0.02)], potassium [WMD = −0.02, 95% CI (−0.06–0.02)], albumin [WMD = −2.08, 95% CI (−3.81, −0.36)], prealbumin [(WMD = −15.37, 95% CI (−33.00–2.27)], daily protein intake [WMD = 0.23, 95% CI (0.17–0.28)], APACHE II score [WMD = 2.65, 95% CI (1.22–4.08)], NRS2002 score [WMD = 0.68, 95% CI (−0.41–1.77)], SOFA score [WMD = 1.87, 95% CI (1.50–2.25)], age [WMD = 8.67, 95% CI (7.14–10.19)], daily calorie intake [odds ratio (OR) = 0.35, 95% CI (0.25, 0.49)], feeding within 48 h of ICU admission [OR = 1.98, 95% CI (1.56, 2.51)], and a history of diabetes [OR = 3.84, 95% CI (1.17, 12.59)] are the risk factors for meta‐analysis in this article. The ROBINS‐I assessment showed moderate‐to‐severe bias (10 severe, 8 moderate). Conclusion: The meta‐analysis identified serum levels of phosphorus and albumin; daily protein and calorie intake; APACHE II score; SOFA score; age; initiation of feeding within 48 h of ICU admission; and a history of diabetes as significant predictors of RFS development in critically ill patients. Serum levels of magnesium, potassium, and prealbumin and the NRS2002 score were not associated with RFS in these patients.