Epidemiological And Prognostic Studies In Critically Ill Patients With Acute Kidney Injury

Part ⅠClinical characteristics and prognosis of critically ill AKI patientsBackground and ObjectiveAcute kidney injury(AKI)is a common clinical syndrome with high incidence and mortality rate,especially in patients in intensive care unit(ICU).Also,surviving patients often fail to recover from renal function and require lifelong renal replacement therapy,severely reducing their quality of life and increasing the financial burden.Since there are no specific drugs for the treatment of AKI at present,the most critical measures to improve the prognosis of patients with AKI are early diagnosis and early intervention.The main purpose of this study was to analyze the clinical characteristics of critically ill patients with AKI and to explore the prognostic factors of in-hospital death.Research Objects and MethodsThe clinical data and laboratory examination results of 530 critically ill patients with AKI admitted to the ICU of Shandong Provincial Hospital from January 2016 to November 2018 were retrospectively analyzed,and the prognostic factors of in-hospital all-cause mortality were analyzed.AKI diagnosis and staging criteria were based on the global organization for the improvement of kidney disease prognosis(KDIGO)guidelines.ResultsAmong the critically ill AKI patients included in this study,the average age of the death group was higher than that of the survival group(P<0.001).The data of the death group was also higher than that of the survival group in terms of the average length of stay in ICU,body temperature,heart rate,urea nitrogen,white blood cells,C-reactive protein and blood glucose levels(P<0.05),however,the data of systolic blood pressure,diastolic blood pressure,mean arterial blood pressure and albumin level in the death group were lower than those in the survival group(P<0.001).In addition,according to the multivariate logistic regression analysis,gender,age,albumin level,mean arterial pressure,body temperature and heart rate were the independent risk factors of hospital death.The area under the curve(AUC)of ROC was 0.774,which was slightly higher than that of APACHEII score(0.747)and SOFA score(0.721).ConclusionAKI is a critical disease with high mortality.The results of this study suggest that the comprehensive effect score of gender,age,albumin level,mean arterial pressure,body temperature and heart rate can be used to predict the prognosis of critically ill patients with AKI.Reasonable use of these indicators is helpful for clinicians to judge the prognosis of hospitalized patients and carry out early intervention to improve the prognosis.Part Ⅱthe relationship between CAR and the prognosis of critically ill patients with AKI researchBackground and ObjectivePrevious studies have shown that inflammation and malnutrition are related to the prognosis of patients with severe AKI,we consider using the comprehensive index CRP/albumin ratio(CAR)to evaluate Long term prognosis,which including inflammation and nutritional status.In order to take effective intervention measures in the early stage of the disease and improve the survival rate.Research Objects and MethodsAccording to the guidelines of the global organization for improving the prognosis of kidney disease(KDIGO),the patients with AKI admitted to the ICU of Shandong provincial hospital from January 2016 to November 2018 were selected.The clinical data and laboratory examination results of the patients were collected,and the patients were followed up by telephone to determine the two-year mortality rate.A total of 378 cases were included in the study.Multiple regression analysis was performed to determine the relationship between car and 2-year mortality in AKI patients,expressed as odds ratio(OR)and 95%confidence interval(CI).ResultsIn 378 cases,208 cases died in two years,accounting for 55%.In both unadjusted and adjusted models,two-year mortality increased with the rise of CAR.For example,in model Ⅱ,after adjusting for age,blood glucose,sodium,respiratory rate,hypertension,cerebral infarction and other factors,the 2-year mortality of high CAR group was 2.6 times higher than that of low CAR group(or=3.6,95%CI 2.0-6.4,P<0.001).In the stratified analysis,it was found that the increase of CAR level in each subgroup was consistent with the increase of 2-year mortality of AKI patients admitted to ICU.The area under the curve of ROC for CAR combined with age was 0.714,which was higher than SOFA score(0.674)and slightly lower than APACHEIIscore(0.734).ConclusionAKI patients often have inflammation and malnutrition.Elevated CAR levels are associated with increased two-year mortality in critically ill patients with AKI.The combined effect score of CAR and age has a certain value in predicting the long-term prognosis of AKI patients.