Risk Factors And Prognosis Of Acute Kidney Injury Induced By Sepsis

Purpose To investigate the risk factors,clinical features and prognosis of acute kidney injury(AKI)induced by sepsis.The predictive value of SOFA scores and APACHE II scores for the mortality of patients with AKI induced by sepsis were compared.Materials and Methods This article retrospectively studied 202 patients with sepsis at the ICU from February 2016 to December 2017 in the Second Hospital of Tianjin Medical University.All patients met the diagnosis of sepsis-3.Patients were classified as sepsis AKI group and non-AKI group according to whether AKI was induced,The AKI group is divided into 1 phase,2 phases,and 3 phases according to the KDIGO(Global Kidney Disease Prognosis Improvement Organization)(2012).The AKI group was divided into survival group and death group according to the survival condition of patients who were transferred out of the ICU or 4 weeks after discharge.The differences in clinical parameters between the sepsis-induced AKI group and the non-AKI group,the AKI patient survival group,and the death group were compared,Univariate and multivariate logistic regression analysis of independent risk factors for morbidity and mortality in patients with sepsis-induced AKI.The SOFA score and APACHE II scoring system use the receiver operating characteristic curve(ROC curve)to compare the predictive value of mortality in sepsis-induced AKI patients.There is a statistical difference(P <0.05).Result 1.In this study,202 patients with sepsis were collected,including 124 males(61.4%)and 78 females(38.6%).The most common were lung infections.There were 108 patients with acute kidney injury induced by sepsis,and the incidence rate was 53.5%.A total of 61 patients with sepsis died with a mortality rate of 30.20%.There were 40 deaths in the sepsis-induced AKI group with a mortality rate of 37.04%.There were 21 deaths in the non-AKI group with a mortality rate of 22.34%.Patients with sepsis AKI had higher mortality than non-AKI patients with statistical differences(χ2 = 5.150,P < 0.05).Among the 108 patients with acute kidney injury,according to the KDIGO staging,48 patients(44.4%)were in phase 1,11 died,and the mortality was 22.9%;28 patients in phase 2(25.9%),including 12 patients Death,mortality rate was 42.9%,32 patients(29.6%)in stage 3,among which 17 patients died and mortality was 53.1%.Based on the survival of patients who were transferred out of ICU or 4 weeks after discharge,108 patients with sepsis-induced AKI were divided into survival group(63.0%)and death group(37.0%).2.Comparison of sepsis-induced AKI and non-AKI groups : Arterial lactate,procalcitonin,urea nitrogen,serum creatinine,APACHE II score,and SOFA scores were higher in the AKI group than in the non-AKI group(P < 0.05).The mean arterial blood pressure and arterial blood PH in the AKI group were lower than those in the non-AKI group(P < 0.05).Multivariate logistic regression analysis showed: mean arterial pressure(OR: 0.976,95% CI: 0.957-0.996,P=0.021),procalcitonin(OR: 1.963,95% CI: 0.934-0.992,P=0.013),APACHE II score(OR: 1.966,95% CI: 0.936 to 0.997,P=0.030)and SOFA score(OR: 1.853,95% CI: 0.769 to 0.945,P=0.002)were independent risk factors for sepsis-induced AKI(P<0.05).3.In the sepsis AKI group,a comparison between the death group and the survivor group showed:Arterial lactic acid,mechanical ventilation,use of vasoactive drugs,blood glucose,APACHE II scores,and SOFA scores were higher in the death group than in the survival group,with statistical differences(P < 0.05).There was a statistically significant difference in the rate of mechanical ventilation and use of vasoactive drugs in the death group compared with the survival group(P < 0.05).Multivariate logistic regression analysis showed mechanical ventilation(OR: 1.257,95% CI: 0.075-0.882,P = 0.031),APACHE II score(OR: 1.932,95% CI: 0.870-0.999,P = 0.043)and SOFA scores.(OR: 1.639,95% CI: 0.507-0.807,P=0.000)was an independent risk factor for death in patients with sepsis AKI(P < 0.05).The ROC curve of the two scoring systems to evaluate the prognosis of patients with sepsis-induced AKI showed: AUC for SOFA score was 0.883(95% CI: 0.807-0.937),and AUC for APACHE II score was 0.784(95% CI: 0.694-0.857).Conclusion Sepsis-induced AKI has higher morbidity and mortality;Mean arterial pressure,PCT,APACHE II score and SOFA score were independent risk factors for sepsis-induced AKI.Low mean arterial pressure,high PCT,high APACHE II score,and SOFA score increased the risk of sepsis-induced AKI;Mechanical ventilation,APACHE II score,and SOFA score were independent risk factors for death from AKI in patients with sepsis.High rates of mechanical ventilation,high APACHE II scores,and SOFA scores increase the risk of sepsis-induced AKI death.The SOFA score was superior to the APACHE II score in predicting the prognosis of patients with sepsis-induced AKI.