Risk Factors Analysis Of Sepsis Complicated With Acute Kidney Injury And Correlation Study Of Angiopoietin 2 And Angiopoietin Like Protein 2

Objective(s):1.Clinical case data of patients with sepsis and sepsis related acute kidney injury were collected,including population distribution,past medical history,infection site,etiological results,antibiotic use,related scores,laboratory data,and adjuvant therapeutic measures,to explore the risk factors which were related acute kidney injury caused by sepsis in patients with sepsis and died of sepsis-associated acute kidney injury.2.Elisa was used to detect peripheral blood angiopoietin 2 and angiopoietin-like protein 2 in patients with sepsis and sepsis related acute kidney injury when admitted to ICU,and to analyze the correlation between angiopoietin 2、 angiopoietin-like protein 2 and the occurrence of sepsis related acute kidney injury in patients with sepsis and death with sepsis related acute kidney injury in patients.Methods:1.Selecting A total of 821 patients who were diagnosed with sepsis and hospitalized in the three intensive care units(ICU)ofthe First People’s Hospital of Yunnan Province Affiliated to Kunming University of Science and Technology from November 2019 to October 2022 as subjects of study,and 404 patients had acute kidney injury among them.The distribution of the patient population,past medical history,infection site,etiological results,antibiotic use,laboratory indicators,SOFA score,APACHE Ⅱ score,adjuvant treatment measures were collected.Patients with sepsis related acute kidney injury were further divided into the survival group(n=161)and the death group(n=243).The difference of clinical data among the groups needs to be analyzed.Risk factors of the occurrence of sepsis acute kidney injury in patients with sepsis and death with sepsis related acute kidney injury in patients needs to be further analyzed.2.The patients were tested by enzyme-linked immunosorption assay in the Emergency Intensive care Unit ofthe First People’s Hospital of Yunnanfrom September 2020 to December 2022)Serum samples of 60 patients with sepsis(including 30 patients with acute kidney injury),30 patients with non-sepsis acute kidney injury admitted to the emergency department,and 30 healthy people were tested for angiopoietin 2 and angiopoietin-like protein 2.To analyze its correlation with the occurrence of sepsis acute kidney injury in patients with sepsis and death with sepsis related acute kidney injury in patients.Results:1.Patients with sepsis and sepsis-associated acute kidney injury was higher in men than in women,and middle and old age is the main age of onset.In the past medical history,the chronic diseases of respiratory system,circulatory system,nervous system,rheumatic immune system,urinary system,gram-positive bacterial infection,gramnegative bacterial infection,fungal infection and there was a significant difference between sepsis patients with acute kidney injury and sepsis patients with unknown pathogen infection(P < 0.05 or P < 0.01).There were significant differences in respiratory chronic disease,circulatory chronic disease,urinary chronic disease(nonchronic renal failure),pulmonary infection,urinary infection and unknown pathogen infection between the death group and the survival group(P < 0.05 or P < 0.01).Statistical analysis shows that age,sex,past medical history,site of infection,related infectious agent,and antibiotic use were not related risk factors for occurrence of sepsis related acute kidney injury and death of sepsis-associated acute kidney injury.2.SOFA score,APACHEⅡ score,procalcitonin(PCT),serum creatinine,urea nitrogen and mechanical ventilation of patients with sepsis and renal injury at ICU were significantly higher than those of patients with sepsis and renal injury(P <0.05),and the central venous pressure,blood purification treatment and blood transfusion treatment of patients with sepsis complicated with acute kidney injury were significantly lower than those of patients with sepsis(P < 0.05),APACHEⅡscore at ICU admission(OR= 0.938,0.913-0.963,P < 0.01),SOFA score at ICU admission(OR=0.808,1.42-1.31,P < 0.01),mean arterial pressure(MAP)(OR=0.81,1.035-2.165,P < 0.05),use of vasoactive drugs(OR=0.54,0.307-0.950,P< 0.05),mechanical ventilation(OR=0.516,0.292-0.912,P < 0.05),PCT(OR=1.01,1.00-1.01,P < 0.01)were risk factors for acute kidney injury in sepsis patients.SOFA score on admission to ICU(OR=1.853,0.769～0.945,P < 0.01),APACHEⅡ score(OR= 1.966,0.936～0.997,P < 0.05),MAP(OR=0.976,0.957～0.996,P < 0.05),PCT(OR=1.963,0.934～0.992,P < 0.05)are independent risk factors for the occurrence of sepsis acute kidney injury in patients with sepsis.3.SOFA score,APACHEⅡ score,PCT,serum creatinine,urea nitrogen and mechanical ventilation of patients who were sepsis related acute kidney injury were observably higher in the death group than in the survival group group(P < 0.05);The central venous pressure,blood purification treatment and blood transfusion treatment of patients who were sepsis related acute kidney injury were observably lower in the death group than in the survival group(P < 0.05).;The severity of acute kidney injury in the death group was also observably higher than that in the survival group(P < 0.05).SOFA score on admission to ICU(OR=0.60,0.491～0.724,P < 0.05),APACHEⅡ score on admission to ICU(OR= 0.89,0.846～0.937,P < 0.01),use of vasoactive drugs(OR=0.38,0.168～0.860,P < 0.05),mechanical ventilation(OR=1.12,0.769～0.985,P < 0.05),lactic acid(OR=0.87,0.769～0.985,P < 0.05)were all risk factors of death in patients with sepsis related acute kidney injury;SOFA score on admission to ICU(OR=1.64,0.507-0.807,P < 0.01),APACHEⅡ score on admission to ICU(OR= 1.93,0.870-0.999,P < 0.05),high mechanical ventilation ratio(OR=1.26,0.075-0.882,P < 0.05)were still independent risk factors for death in patients with sepsis related acute kidney injury.The AUC of SOFA score at ICU was0.755(95%CI0.708-0.802),P=0.000,sensitivity was 62.8%,specificity was 79.4%,Youden index: 0.422,and the optimal cut-off value was 8.5 points.When admitted to ICU,the AUC of APACHEⅡ score was 0.788(95%CI0.7444-0.832),P=0.000,sensitivity was 78.9%,specificity was 66.22%,Youden index was 0.451,and the best cut-off was 17.5 points.There was no significant difference between SOFA score and APACHEⅡ score when admitted to ICU(P > 0.05).According to the analysis,SOFA score and APACHEⅡ score when admitted to ICU admission were positively correlated mortality in patients with sepsis related acute kidney injury in this study.5.The blood Ang-2 and blood Angptl2 when admitted to ICU contents of sepsis patients with acute kidney injury in the death group were observably higher than those in the survival group,with statistical difference(P < 0.05);ROC analysis showed that the AUC of blood Ang-2 when admitted to ICU was 0.867(95%CI0.741--0.992),P=0.001,sensitivity was 76.9%,specificity was 82.4%,Youden index was 0.593,and the optimal cut-off value was 17.52ng/ml.The AUC of blood Angptl2 when admitted to ICUwas 0.919(95%CI0.818-1),P=0.000,sensitivity was 100.0%,specificity was82.4%,Youden index was 0.824,and the optimal cut-off value was 6.91ng/ml.The AUC of Ang-2 related Angptl2 was 0.903(95%CI0.797-1),P=0.000,sensitivity was92.3%,specificity was 76.5%,Youden index was 0.688,and the best truncation value was 21.80ng/ml.Analysis showed that blood Ang-2 at admission to ICU,blood Ang-2 at admission to ICU,blood Angptl2 at admission to ICU,blood Angptl2 at admission to ICU,blood Angptl2 at admission to ICU,blood Angp TL2 is more valuable for the prediction of death in sepsis patients with acute kidney injury.Conclusion(s):1.High SOFA score,high APACHEⅡ score,low MAP and high PCT at ICU admission were independent risk factors for acute kidney injury in sepsis patients.2.High SOFA score,high APACHEⅡ score and high mechanical ventilation ratio at ICU were independent risk factors for death in sepsis-associated acute kidney injury;3.The indexes of Ang-2 and Angptl2 on admission to ICU are of important reference value for the early diagnosis of acute kidney injury in sepsis patients and the evaluation of sepsis complicated with acute kidney injury.4.The value of the combined test index of Ang-2 and Angptl2 in patients admitted to ICU is better than that of the separate test index of Ang-2 and Angptl2 in patients admitted to ICU,and the higher the combined index is,the more likely patients are to develop acute kidney injury.5.The evaluation value of blood Angptl2 index in patients with sepsis complicated with kidney injury in ICU is better than that of blood Angptl2 index in ICU and its combined detection index with blood Angp TL2 index in ICU.The higher the index is,the higher the probability of death is.