Abstract: Objective   Aim To analyze the levels of soluble leukocyte differentiation antigen CD14 subtype(Presepsin) and Toll-like receptor 4(TLR4) in patients with acute pancreatitis(AP) and their value in assessing the risk of renal injury.  Methods   A total of 132 patients with AP in our hospital from June 2020 to December 2021 were selected,and 66 healthy subjects were selected during the same period.The serum Presepsin and TLR4 levels were detected in both AP patients and healthy subjects.Spearman correlation coefficient was used to analyze the correlation between serum Presepsin and TLR4 levels and disease severity in AP patients.The influencing factors of renal injury in AP patients and the interaction of Presepsin and TLR4 levels on the risk of renal injury were analyzed.Receiver operating characteristic(ROC) curve was used to analyze the value of serum Presepsin and TLR4 in predicting renal injury in AP patients,and the decision curve and clinical impact curve were used to verify.  Results   The serum Presepsin and TLR4 levels in AP patients were higher than those in healthy people(P＜0.05).The serum Presepsin and TLR4 levels in AP patients were positively correlated with the severity of the disease(r₁=0.794，P₁＜0.001；r₂=0.835，P₂＜0.001).Serum Presepsin and TLR4 levels were the influencing factors of renal injury in AP patients(P＜0.05).Serum Presepsin and TLR4 had a synergistic effect on renal injury in AP patients,and the synergistic effect was 1.095 times the sum of the effects of the two alone(SI=1.095).When serum Presepsin>1 021.88 ng/L and TLR4>31.85 ng/ml,AP patients had a higher risk of renal injury,and the AUC value of combined detection was 0.851.Within the threshold range of 0.12 to 0.78,the combined assessment of Presepsin and TLR4 for the net benefit rate of renal injury in patients with AP was superior to the independent detection.At each threshold probability,the number of people classified as high risk by the joint detection scheme and the number of true positive cases were basically consistent when the threshold probability was 0.51.  Conclusion   After the occurrence of AP,the levels of serum Presepsin and TLR4 increase abnormally with the severity of the disease.The high levels of serum Presepsin and TLR4 are independent risk factors for renal injury in AP patients,and the two have a synergistic effect on the occurrence of renal injury.Horizontal assessment of the risk of renal injury has high value and it can provide early warning in clinical practice.

Key words: acute pancreatitis, kidney injury, soluble leukocyte differentiation antigen CD14 isoform, Toll-like receptor 4