Risk Factors Analysis Of Acute Kidney Injury In Severe Neurological Disease

Objective: Acute Kidney injury(AKI)often occurs in severe neurological patients due to their special pathophysiological conditions and treatment methods.This retrospective analysis was conducted to explore the risk factors and prognostic factors of acute kidney injury in these patients.Methods: A total of 116 patients with severe neurological disease admitted to the intensive care unit of Huangshan People’s Hospital from January 2015 to January 2021 were selected.According to the occurrence of AKI,the patients were divided into AKI group(46 cases)and non-AKI group(70 cases).The patients in AKI group were divided into survival group(32 cases)and death group(14 cases)according to the prognosis.The Glasgow Coma Score(GCS),acute physiology and chronic health status Score Ⅱ(APACHEL),and Mean Arterial Pressure(Arterial Pressure)before the diagnosis of AKI were collected.MAP),Serum lactic acid,Serum sodium,blood glucose,White blood cell count(WBC),C-reactive Protein(CRP),Cystatin C,Serum Creatinine.SCR,Blood nitrogen(BUN),and the proportion of patients undergoing craniocerebral surgery,using mechanical ventilation,using dehydrating agents(mannitol,albumin),using norvancomycin,using noradrenaline,etc.Multivariate Logistic regression analysis was conducted to screen out the risk factors leading to neurologic severe patients complicated with AKI and the related factors affecting the prognosis.Receiver operating characteristic curve(ROC)was drawn to evaluate the predictive effect of serum lactic acid on the occurrence of AKI in patients with severe neurological disorders,and to test the predictive ability of cystatin C in the occurrence of AKI.Results: In this group of 116 neurosevere patients,AKI occurred in 46 cases(39.7%).The in-hospital mortality in AKI group was significantly higher than that in non-AKI group(30.4% vs.14.3%,P<0.05%).Compared with the non-AKI group,mannitol ratio(82.6% vs.65.7%),mean arterial pressure MAP(mm Hg: 82.57 ± 25.97 vs.94.3 ±31.58),blood lactic acid(mmol/L: 4.56±2.79 vs.2.42±1.66),blood sodium(mmol/L:145.04±8.79 vs.141.79±7.11),blood glucose(mmol/L: 10.51±2.76 vs.9.13±2.73),Cystatin C(mg/L: 1.31 ± 0.55 vs.0.83 ± 0.36).There were statistically significant differences in the above indicators between the two groups(P<0.05),and no statistically significant differences in the observation indicators between the other two groups.Multivariate Logistic regression analysis showed that high blood lactic acid [odds ratio(OR)=1.882,95% confidence interval(95%CI)=1.391-2.456,P<0.05] and high cystatin C[odds ratio(OR)=18.381,95% confidence interval(95%CI)=4.603-73.398,P<0.05],is an independent risk factor for AKI in neurosevere patients.ROC analysis showed that blood lactic acid had moderate predictive value for acute kidney injury in patients with severe neurological conditions.When the area under the ROC curve(AUC)was 0.772,the cut-off value was 2.720,the sensitivity was 0.783,and the specificity was 0.700,P<0.05.Cystatin C also had moderate predictive value,with an area under the ROC curve(AUC)of 0.799,a truncation value of 1.115,a sensitivity of 0.674 and a specificity of 0.866,P<0.05.Conclusions:Acute kidney injury is a common complication in patients with severe neurological disease,with a rate of 39.7%,most of which occurs within 5 days after admission to ICU.The occurrence of AKI increased the mortality of patients with severe neuropathy,and the mortality of AKI group was 30.4%.Mannitol,hyperlactatemia,hypomap,hypersodium,hyperglycemia,and cystatin C are all high risk factors for AKI in patients with severe neuropathy.High blood lactic acid and high cystatin C are independent risk factors for AKI in neurosevere patients,and both have moderate predictive value for AKI.