Analysis Of The Incidence And Risk Factors Of AKI In Patients With Invasive Mechanical Ventilation In ARDS

Objective: This study intends to collect and analyze the incidence,mortality and related risk factors of acute kidney injury(AKI)in patients with acute respiratory distress syndrome(ARDS)receiving invasive mechanical ventilation(IMV)in the department of critical care medicine,which can help clinical Physicians understand the epidemiology of acute kidney injury in patients with respiratory distress syndrome undergoing invasive mechanical ventilation,and respond to the occurrence of kidney injury early to provide a reference for early clinical identification and prevention of ARDS-IMV-AKI.Methods: The patients came from 2019.01.01-2020.01.01.Adult patients who were admitted to the ICU of TAIZHOUPeople’s Hospital for invasive mechanical ventilation and had ARDS were the research subjects.A total of 144 cases were included.Among them,24 cases were excluded because they did not meet the enrollment conditions and were finally included in 120 Data collection was performed on each patient.Collect demographic data,clinical characteristics,underlying diseases,laboratory indicators,related treatments and score sheets,etc.,and investigate the incidence and clinical characteristics of AKI in patients who meet the criteria for enrollment.The patients who meet the research objects were divided into AKI group and non-AKI group,and single factor analysis and binary logistic regression analysis were performed successively to obtain independent risk factors for AKI in ARDS patients with invasive mechanical ventilation.The Kaplan-Meir survival analysis was used to draw a chart to illustrate the relationship between the patient’s hospital stby and mortblity to evaluate the impact of acute kidney injury on the patient’s prognosis.Results: The average age of onset was 64.2 years,and males accounted for 64.2%.The incidence of AKI among all patients included in the study was 47.5%(57/120)and the mortality rate was 38.33%(46/120).Among them,the mortality rate of AKI group was 59.64%(34/57),and the mortality rate of non-AKI group was 19.04%.(12/63).According to AKI staging,there were 13 cases of stage I AKI with a mortality rate of38.4%;16 cases of stage II AKI with a mortality rate of 62.5%;24 cases of stage III AKI with mortblity rbte of 79.1%.Compared with patients with non-AKI group,the mortality rate of AKI patients increased significantly.Kaplan-Meir survival curve showed that the occurrence of AKI was significantly related to the poor prognosis of hospitalized patients(P<0.001).Among 120 patients with ARDS,they were divided into seven categories according to the etiology of ARDS.Among them,35 cases of pneumonia(29.1%),the incidence of AKI was 48.5%(17/35);28 cases of sepsis(23.3%),and AKI The incidence rate was 60%(15/28);17 cases of multiple injuries(14,1%),the incidence rate of AKI was 23.5%(4/17);12 cases of aspiration(10%),the incidence rate of AKI was 50%(6 /12);12 cases of poisoning(10%),the incidence of AKI was 58.3%(7/12);6 cases of pancreatitis(5%),the incidence of AKI was 66.7%(4/6);others(8.3%)In 10 cases,the incidence of AKI was 40%(4/10).The main causes of ARDS are pneumonia and sepsis.Among the various causes of ARDS,the highest risk of AKI is pancreatitis and sepsis.In univariate analysis,the history of surgery in the past 6 months,unconsciousness,hypercapnia,basal creatinine level,the highest value of creatinine in seven days,decreased PH,positive urine occult blood,increased white blood cell count,CRP,PCT,acute physiology and chronic The health-Ⅱscore and SOFA score is statisticblly different(P<0.05).Multivariate regression analysis tell us PCT is an independent risk factor for AKI in patients with invasive mechanical ventilation in ARDS(OR value 1.168,95% CI 1.049-1.301).As PCT increases,the risk of AKI is greater(P=0.005);Basic creatinine is an independent risk factor for AKI in patients with ARDS invasive mechanical ventilation(OR value 2.233,95% CI 1.383-3.605).As the basic creatinine value increases,the risk of AKI is greater(P <0.001);PH value is an independent risk factor for AKI in ARDS patients with invasive mechanical ventilation(OR value 1.488,95% CI 1.081-1.890).With the decrease of arterial blood gas PH value,the greater the risk of AKI(P=0.01);Unconsciousness is an independent risk factor for AKI in ARDS patients with invasive mechanical ventilation(OR value 1.072,95% CI 1.081-1.890).As unconsciousness occurs,the greater the risk of AKI(P=0.002);SOFA score is an independent risk factor for AKI in ARDS patients with invasive mechanical ventilation(OR value 3.672,95%CI 2.227-5.760).As the SOFA score value increases,the risk of AKI is greater(P<0.001);Conclusion: 1.In the ICU,the incidence of acute kidney injury in patients with ARDS receiving invasive mechanical ventilation is 47.5%,of which the overall mortality rate is 38.33%,and the incidence and mortality of AKI are relatively high.The mortality rate of 34 cases(59.64%)in the AKI group was significantly higher than that in the non-AKI group in 12 cases(19.04%).2.The main cause of ARDS in ICU is infection,and pneumonia and sepsis are the main causes of ARDS in severely ill patients.Among the various causes of ARDS,the highest risk of AKI is pancreatitis and sepsis.3.PCT,unconsciousness,SOFA score,PH value,and basic creatinine level are the risk factors for AKI in patients with ARDS invasive mechanical ventilation.Ranked by the degree of influence are: SOFA score,basic creatinine level,PH value,PCT,unconsciousness.