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Abstract: Objective To investigate the predictive value of serum tight junction protein zonulaoccludens 1 (ZO-1), occludin, claudin-1, combined with acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) score on hypertriglyceridemia-induced severe acute pancreatitis(HTG-SAP) complicated with acute kidney injury (AKI) . Methods A total of 96 patients withHTG-SAP admitted from January 2021 to March 2024 were retrospectively studied and divided intoAKI group (n = 38 ) and non-AKI group ( n = 58 ) according to whether they had concurrentAKI. Differences in clinical data and serum ZO-1, occludin, and claudin-1 levels were compared between the two groups. Factors with statistically significant differences were screened as independent variables for logistic regression analysis, and a prediction model was constructed. The predictive value of each index on HTG-SAP complicated AKI was analyzed by the receiver operating characteristiccurve. Results The APACHEⅡ score, systemic inflammatory response syndrome score, triglyceride, serum creatinine and blood urea nitrogen levels in the AKI group were higher than those in thenon-AKI group, and serum ZO-1, occludin, and claudin-1 levels were lower than those in the nonAKI group, the differences were statistically significant ( P < 0. 05) . Logistic regression analysisshowed that the increased of APACHEⅡ score (OR = 1. 781, 95 % CI: 1. 065-2. 981), and thedecreased levels of serum ZO-1 (0. 956, 95 % CI: 0. 918-0. 995), occludin (0. 967, 95 % CI:0. 941-0. 995) and claudin-1 ( 0. 193, 95 % CI: 0. 049-0. 752 ) were risk factors for AKI inHTG-SAP patients (P< 0. 05) . The area under the curve of APACHEⅡ score and serum ZO-1, occludin, claudin-1 alone and combined models in predicting AKI in HTG-SAP patients were 0. 821(95 % CI: 0. 740-0. 902), 0. 852 (95 % CI: 0. 740-0. 902), 0. 877 (95 % CI: 0. 807-0. 947),0. 936 (95 % CI: 0. 891-0. 981), 0. 998 (95 % CI: 0. 993-1. 000), respectively. Conclusion  The decrease of serum tight junction proteins ZO-1, occludin, and claudin-1 and the increase of APACHEⅡ score are the risk factors of AKI in HTG-SAP patients. Establishing a prediction model according to these four indexes has good value in predicting AKI in HTG-SAP patients.

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