Clinical Study On Hospital-acquired Acute Kidney Injury Of Critically Ill Patients

Background and Objective Hospital-acquired acute kidney injury (HA-AKI) is because of some aggravated primary disease or iatrogenic factors such as renal hypoperfusion, medicine, surgery, severe infection, ischemia, anoxia and other reasons, patients with normal kidney function on admission were acquired acute kidney injury (AKI) in hospital. If the clinician failed to have proper awareness of HA-AKI, the pathogenetic condition of patients would aggravate and even die, because of its higher morbility and mortality. At present, the mortality rate of HA-AKI has not dropped significantly, even with the improved success rate of AKI treatment resulted from the application of continuous blood purification techniques. Therefore, the study on the HA-AKI's morbility, the relationship with his primary disease, susceptibility and prognosis and so on in critically ill patients will help improve the clinician's awareness of HA-AKI and have a positive effect on effective prevention, prompt diagnosis and early treatment of HA-AKI. In this way, HA-AKI's occurrence can be reduced or avoided, its progress can be improved, the patient's mortality will be reduced and the cure rate be higher. Moreover, it also plays an important role in reducing the patient's medical costs.Methods The research analyzes retrospectively 251 critically ill patients with HA-AKI out of 2636 cases in ICU from January 2001 to June 2009. The clinical datum was included of their vital signs, blood routine test, biochemistry, arterial blood gas analysis and treatment measures on admission, HA-AKI's onset, after the treatment and at discharge, estimated APACHEⅡand MODS score. According to their prognosis, the patients with HA-AKI were divided into the cured group, the none-cured group and the death group. The patients'clinical datum before and after HA-AKI were compared between the cured group and the death group. Normal distribution data was indicated by±s and used two independent sample T-test and nonnormal distribution data was indicated by median(P25,P75)and used two independent sample rank sum test. The comparison of the datum in two groups was conducted by usingΧ2 test, the correlation analysis between two factors used linear correlation analysis and the analysis of multi-factors used logistic regression analysis. All datum was analyzed by statistical software SPSS 13.0.Results The morbility of HA-AKI in ICU was 9.52%, the mortality was 51.79%. The total interval of hospitalization was18.18±12.63d(7～46d), the average time from admitting to HA-AKI was 6.45±5.07d(2～16d), the average time from HA-AKI's occurrence to restoring normal kidney function was 4.52±2.29d(2～12d), the time from HA-AKI's occurrence to curing and discharge was 19.62±15.08d(2～58d), the average time from HA-AKI's occurrence to death was 6.57±5.74d(1～40d), and the average time from HA-AKI's occurrence to none-curing and discharge was 3.98±3.20d(1～19d). The blood pressure, Hct and BPC in HA-AKI were lower than those on admission (P﹤0.01). And WBC, serum total bilirubin, CVP, APACHEⅡand MODS score in HA-AKI were higher than those on admission (P﹤0.01). Compared with the cured group, Hct, mean arterial pressure of the death group on admission were lower (P﹤0.05) and APACHEⅡscore was much higher (P﹤0.01); there were more patients with lower CVP in the death group (P﹤0.05). When occurring HA-AKI, blood urea nitrogen, urea acid, creatinine and MODS score in the death group were higher (P﹤0.05), APACHEⅡscore is also higher (P﹤0.01), and arterial blood pressure is lower (P﹤0.01). The patients of using mechanical ventilation in the treatment, with shock or systemic inflammatory response syndrome (SIRS) in the death group were more than that in the cured group (P<0.01,0.05,0.05).Conclusions There was a higher morbidity of HA-AKI in critically ill patients. Shock, lack of effective circulating blood volume and higher critical score were common predisposing factors of HA-AKI. Serum urea nitrogen, creatinine, shock, systemic inflammatory response syndrome, using mechanical ventilation in the treatment and so on were the risk factors that affect prognosis.