Exploration The Early Warning Value Of Renal Resistance Index And Renal Regional Tissue Oxygen Saturation In Acute Kidney Injury

Part Ⅰ risk factors of septic shock with acute kidney injury;A retrospective study Objective we retrospectively analyzed the clinical data of 89 children who incurred septic shock to provide evidence of early diagnosis,treatments and improving prognosis for children who have septic shock and acute kidney injury（AKI）.Methods Eighty-nine septic shock children were selected from June 2013 to December 2018 in the Pediatric Intensive Care Unit（PICU）of Capital Institute Pediatrics.They were divided into 2 group according to if they had AKI.One was experiment group which had AKI,while another one was control group.Then we used SPSS25.0 software to analyze the clinical data with univariate and multivariate analysis.Results The mortality of experiment group and control group were 46.43%（26/56） and 39.39%（13/33）respectively.Both groups were obvious differences between two group in Pediatric Critical Illness Score（PCIS）,the number of organ failure,nervous failure,hepatic failure,circulatory failure,lactic acid,creatinine,urea,total bilirubin,direct bilirubin（P<0.05）.Logistic regression showed that hepatic failure（OR 0.099,95%CI 0.018～0.549）,PCIS<80（OR 0.223,95%CI 0.064～0.774）,lactic acid>4.1mmol/L（OR 0.221,95%CI 0.055～0.885）were independent risk factors for septic shock with AKI.Conclusion The mortality of septic shock with AKI is high.Hepatic failure,PCIS<80,lactic acid>4mmol/L were independent risk factors.Part Ⅱ: To explore the clinical significance of renal resistance index and renal tissue oxygen saturation in early prediction of acute renal injury: A perspective study Objective To explore the clinical significance of renal resistance index（RI）and renal tissue oxygen saturation in predicting AKI occurrence within 24 h of admission.Methods During December 2020 and March 2021,we prospectively collected all the patients’ clinical data within 24 h of admission including the baseline data.We used ultrasound to obtain renal Doppler ultrasound and used Near Infrared Spectroscopy（NIRS）to monitor the renal tissue oxygen saturation,also we used USCOM to monitor the hemodynamic index of peripheral circulation.Then we used SPSS25.0 software to analyze all the data.Results A total of 66 patients were recorded continuously.The incidence of AKI within 72 hours after admission was 19.70%（13/66）.High risk factors（shock,tumor,severe infection,etc.）increase the incidence of AKI to three times.The patients were divided into 2 groups including study group（AKI patients）and control group（none AKI patients）.Univariate analysis showed that both groups were the length in hospital,white blood cell count（WBC）,C-reactive protein（CRP）,Cr,RI,ejection fraction（EF）were statistically different（p<0.05）,Semi-quantitative score（p=0.053）,pulsatility index（PI）（p=0.051）and PCIS and peripheral vascular resistance index were not statistically different.Receiver operating characteristic（ROC）showed that the sensitivity of RI> 0.635 to predict AKI in patients was 0.889.The specificity is 0.552,Area under curve（AUC）is 0.751.The sensitivity of predicting AKI in PICU patients with renal tissue oxygen saturation <43.95% was 0.615.The specificity is 0.719 while the AUC is 0.609.The sensitivity,specificity and AUC of the combined the both RI and renal tissue oxygen saturation were 0.889,0.552,0.766.Conclusion The incidence of AKI in PICU is still high and high risk factors will improve the incidence of AKI.RI has some clinical significance in early prediction of AKI and the combination of renal tissue oxygen saturation and RI will increase such clinical significance,which can provide a new noninvasive way for early diagnosis and prediction AKI.