| Object1. To investigate the cause, clinical manifestation. theraphy and prognosis in acute kidney injury (AKI) patients receiving continuous renal replacement therapy (CRRT). To study the predictive value of mean platelet volume (MPV) for in-hospital mortality of patients with severe acute kidney injury.2. To investigate the cause, clinical manifestation, theraplu and prognosis in acute cardiorenal syndrome (ACRS) patients receiving continuous renal replacement therapy (CRRT). To study t the predictive value of mean platelet volume (MPV) for in-hospital mortality of patients with acute cardiorenal syndrome.3. To evaluate the relationship between mean platelet volume, dyslipidemia and urinary protein excretion in diabetic kidney disease (DKD) patients.MethodThe first partA total of 223 subjects of severe AKI patients were enrolled in our hospital from January 2009 to December 2014. All the patients were received CRRT. Clinical data of adult patients were retrospectively analyzed. Subjects were classified according to Age. Prognosis and Treatment timing. The best clinical cut-off values of MPV for in-hospital mortality were found by ROC curve. The influencing factors for the in-hospital mortality of severe AKI were analyzed by univariate. multivariate and logistic regression analysis.The second partA total of 35 subjects of ACRS patients were enrolled in our hospital from January 2009 to December 2014. All the patients were received CRRT. Clinical data of adult patients were retrospectively analyzed. Subjects were classified according to Prognosis and Treatment timing. The best clinical cut-off values of MPV for in-hospital mortality were found by ROC curve. The influencing factors for the in-hospital mortality of ACRS with CRRT were analyzed by univariate. multivariate and logistic regression analysis.The third partA total of 122 DKD patients (49 females and 73 males) with an average age of 62.26±12.67 were enrolled in this study.24-hour urine were collected for 24-h protein(24hpro) measurement and blood samples were for lipid parammeters. According to 24h pro assays, subjects were divided into two groups:nephrotic group and non-nephrotic group. Lipid profiles, MPVand correlation analysis were compared between the two groups.Results1. In all AKI patients, average age was 61.4 years (rang 17～99 years) Department of nephrology accounted for the highest proportion, followed by intensive care unit (ICU). ACRS was the most common cause of AKI, followed by severe sepsis and trauma. There were 115 (51.6%) survivals and 108 (48.4%) deaths. Compared with Youth group, the mortality rate of Elderly group was significantly higher (P<0.01). The prognosis of Early intervention group was significantly better than Late intervention group (P<0.05). The best clinical cut-off values of MPV for in-hospital mortality was 12.15fl. The mortality of patients with more than and less than the cut-off values of MPV were 64.0% and 40.5% with statistically significant differences(P<0.01). Logistic regression analysis showed that average number of organ failure (OR=2.569), the score of APACHE Ⅱ (OR=1.190), usage of vasopressors (OR=28.166) were risk factors for the in-hospital mortality of AKI patients.2. Among the patients, average age was 69.2 years (rang 29-87 years). Acute myocardial infarction (AMI) was the most common cause of ACRS. There were 17 (48.6%) survivals and 18 (51.4%) deaths. Age, average number of organ failure, APACHE II score, the proportion of usage of pressor agent, mean platelet volume(MPV), blood urea nitrogen(BUN) and Fasting blood glucose(FBG) in the Death group were significantly higher than those in the Survival group (P<0.05,0.01 respectively). Whereas, the proportion of NYHA cardiac function grading, mean arterial pressure were significantly lower than those in the Survival group (P<0.05,0.01 respectively). The prognosis of Early intervention group was significantly better than Late intervention group.The best clinical cut-off values of MPV for in-hospital mortality was 12.15fl. The mortality of patients with more than and less than the cut-off values of MPV were 90.9% and 33.3% with statistically significant differences (P<0.01). Logistic regression analysis showed that only APACHE Ⅱ (OR=1.190) was risk factors for the in-hospital mortality of ACRS patients.3. The levels of total cholesterol(TC). non high density lipoprotein (NHDL). lipoprotein (a) [Lp(a)]. apolipoprotein B (ApoB) were much higher in nephrotic group compared with non-nephrotic ones (P<0.05). In correlation analysis, TC, NHDL. Apo-B and Apo-E were found to be related with 24h urine protein and HbAlC (P<0.01) respectively and Lpa was related with 24hpro and eGFR. LDL-C and TG were independently associated with HbAlC (P<0.01) while Apo-Al was only associated with 24hpro (P<0.05). MPV was only associated with glycated albumin (GA) (P<0.05). In each group classified according to quartiles of lipid profile, we found that the proportion of patients with>3.5g/24h urine protein excretion grew progressively with increase of TC. NHDL-C, TG. Apo-Al. Apo-B, Lpa and Apo-E (P<0.05) while LDL-C and HDL-C has no statistical differences (P>0.05).Conclusion1. Our retrospective study showed that the prognosis of patients with acute kidney injury who received CRRT was poor, and the risk factors included average number of organ failure. APACHE II scores, usage of vasopressors. MPV has predictive value for the in-hospital mortality of AKI patients receiving CRRT.2. Our retrospective study showed that the prognosis of patients with acute cardiorenal syndrome who received CRRT was poor, and the risk factors included age. APACHE Ⅱ scores, MPV, etc. MPV has predictive value and was risk factors for the in-hospital mortality of ACRS patients receiving CRRT.3. In patients with diabetic kidney disease, elevated MPV and obvious dyslipidemia were observed with increase of 24h urine protein excretion, especially in those with nephrotic syndrome who mainly present with an elevation of TC. NHDL. Lpa and Apo-B. Since dyslipidemia could aggravate the progress of kidney disease, an effective control of lipid profile is likely to improve the prognosis. |
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