Characteristics, Prognosis Analysis And Distribution Of TCM Syndromes Of Patients With Acute Kidney Injury In ICU Of A Traditional Chinese Medicine Hospital

Objective:To study the risk factors of acute kidney injury(AKI),the risk factors of renal function prognosis,the risk factors of death and the distribution characteristics of TCM syndrome elements in the intensive care unit(ICU)of Dongzhimen Hospital of Beijing University of Chinese medicine.Methods:Included in the ICU of Dongzhimen Hospital of Beijing University of Chinese medicine from November 2014 to November 2019 who met the AKI diagnostic criteria of the kidney disease improving global outcomes,The general data,basic diseases,complications,critical illness score,laboratory test data,treatment and clinical outcome were collected to study the risk factors of AKI,the risk factors of renal function prognosis,the risk factors of death and distribution characteristics of TCM syndrome elements.Results:(1)According to the inclusion criteria,149 patients were enrolled.The incidence of AKI was 65.10%,and the median time to onset of AKI was 11 days.Stage 1,2 and 3 of AKI accounted for 16.49%,20.62%and 62.89%respectively.The causes of prerenal,renal and postrenal accounted for 70.10%,27.84%,and 2.06%respectively.(2)According to whether AKI occurred or not,the results showed that 97 patients(65.10%)in the AKI group,52 patients(34.90%)in the non-AKI group,and the proportion of males in the AKI group was higher than that in the non-AKI group(P<0.05).The proportion of AKI group combined with oliguria or anuria,acidosis,shock,multiple organ failure and the number of organ failure were higher than those in the non-AKI group(P<0.05).The use rates of dopamine,norepinephrine,mechanical ventilation and substitution therapy in the AKI group were higher than those in the non-AKI group.The use rate of traditional Chinese medicine decoction was lower than that in the non-AKI group(P<0.05).The SOFA score and APACHE II score of the AKI group were higher than those in the non-AKI group(P<0.05).The values of white blood cells(WBC),C-reactive protein(CRP),procalcitonin(PCT),serum kalium(K+),admission blood urea nitrogen(BUN),admission serum creatinine(Scr),and discharge Scr in the AKI group were higher than those of the non-AKI group,and the PH of the AKI group was lower than that of the non-AKI group(P<0.05).Multivariate logistic analysis showed that the number of organ failure(OR=1.796,P<0.05),the application of dopamine(OR=3.935,P<0.05),SOFA score(OR=1.325,P<0.05)and APACHE II score(OR=1.096,P<0.05)were independent risk factors for the onset of AKI.Using the number of organ failure,dopamine,norepinephrine,SOFA score and APACHE ? score to predict the occurrence of AKI,the area under the curve were 0.814,0.733,0.703,0.887 and 0.830 respectively.(3)AKI patients were grouped according to whether the renal function was recovered or not.The results showed as follows:28 patients(28.87%)in the renal function recovery group,69 patients(71.13%)in the renal function non-recovery group,and the use rate of traditional Chinese medicine decoction in the renal function recovery group was higher than that in the renal function non-recovery group.The SOFA score in the renal function non-recovery group was higher than that in the renal function recovery group(P<0.05).The values of blood glucose(GLU)and Scr in the non-recovery group were higher than those in the recovery group(P<0.05).Multivariate logistic analysis showed that the use of traditional Chinese medicine decoction(OR=0.192,P<0.05)for syndrome differentiation showed a certain protective trend in affecting the recovery of renal function in AKI patients.(4)Grouped according to clinical outcome,the results showed that 106 patients(71.14%)in the death group,43 patients(28.86%)in the survival group.The proportion of death group combined with oliguria or anuria,shock,multiple organ failure,AKI and the number of organ failure were higher than those in the survival group(P<0.05).The use rates of antibiotics,dopamine,mechanical ventilation and norepinephrine in the death group were higher than those of the survival group(P<0.05).The SOFA score and APACHE ? score in the death group were higher than those of the survival group(P<0.05).The values of CRP,GIU and discharge Scr in the death group were higher than those of the survival group(P<0.05).Multivariate logistic analysis showed that shock(OR=6.289,P<0.05),application of norepinephrine(OR=5.269,P<0.05)and APACHE II score(OR=1.107,P<0.05)were independent risk factors for death in ICU patients.The AUC of shock,norepinephrine,dopamine and APACHE ? score in predicting death in ICU patients were 0.767,0.762,0.606 and 0.808 respectively.(5)In terms of disease nature,pure deficiency syndrome,mixed deficiency and excess syndrome and pure excess syndrome accounted for 11.34%,58.76%and 29.90%of AKI patients in ICU,while pure deficiency syndrome,mixed deficiency and excess syndrome and pure excess syndrome accounted for 13.46%,36.54%and 50.00%of non-AKI patients respectively.Most AKI patients were mixed deficiency and excess syndrome and most non-AKI patients were excess syndrome(P<0.05).In terms of deficiency syndrome elements,In AKI group,there were 39 cases(40.21%)with Qi deficiency,9 cases(9.28%)with blood deficiency,47 cases(48.45%)with Yin deficiency and 23 cases(23.71%)with Yang deficiency,among which Yin deficiency was the most,followed by Qi deficiency.In terms of excess syndrome elements,there were 40 cases(41.24%)with fire heat syndrome,42 cases(43.30%)with blood stagnation syndrome,50 cases(51.55%)with phlegm syndrome and 24 cases(24.74%)with water retention syndrome,among which phlegm syndrome was the most,followed by blood stagnation syndrome.The incidence of Yin deficiency syndrome and Yang deficiency syndrome in AKI patients was higher than that in non-AKI patients(P<0.05).There was no statistical difference in TCM syndromes among patients with different renal function prognosis and clinical outcome.Conclusion:(1)The incidence of AKI in the ICU of this hospital was 65.10%,and the majority of AKI patients was male.The main etiology of AKI was prerenal,and the main stage of AKI was stage 3.(2)The number of organ failure,the application of dopamine,SOFA score,and APACHE II score were independent risk factors for AKI in ICU patients,and had certain predictive value for the occurrence of AKI.(3)The use of traditional Chinese medicine decoction for syndrome differentiation showed a certain protective trend in affecting the recovery of renal function in AKI patients.(4)APACHE II score,shock and application of norepinephrine are independent risk factors for death in ICU patients,and have certain predictive value for the clinical outcome of ICU patients.(5)The disease nature of AKI patients in the ICU is mainly mixed deficiency and excess syndrome.Yin deficiency is the most common deficiency syndrome,followed by Qi deficiency.Phlegm syndrome is the most common excess syndrome,followed by blood stagnation.The incidence of Yang deficiency syndrome and Yin deficiency syndrome in AKI patients is higher than that in patients without AKI.To sum up,for the treatment of critically ill patients,we should pay attention to avoid the factors that may induce AKI,especially prerenal factors,reasonably use vasoactive drugs,actively evaluate the function of various organs,combine traditional Chinese and Western treatment methods,and pay attention to the application of nourishing Yin and replenishing Qi,resolving phlegm and removing blood stasis in combination with the characteristics of TCM syndromes in the treatment of AKI,so as to give full play to the unique advantages of TCM in improving renal function.