Prognostic Analysis Of Blood Purification On Multiple Organ Dysfunction Complicated With Acute Kidney Injury

Objective:To study the prognosis of multiple organ dysfunction syndrome (MODS) complicated with acute kidney injury (AKI) treated by continuous blood purification, And evaluate the clinical value for prognosis of Kidney Disease:Improving Global Outcomes (KDIGO)guidelines.Methods:collected clinical data of patients from2011July to2012December in critical care unit of Eastern Hospital of Shangdong Provincial Hospital.During that phase,57patients diagnosed with MODS complicated with AKI and underwent blood purification therapy were selected and grouped according to KDIGO staging.Their clinical data before underwent blood purification therapy were collected.The patients were grouped according to the ICU prognosis, namely death and survival, the differences between the two groups were analyzed,then Multinomial logistic regression as well as univariate logistic regression analysis were conducted to explore the prognosis factors.Results:57patients diagnosed with MODS complicated with AKI and underwent blood purification therapy were selected,and numbers in each group by KDIGO staging were respectively16,17and24.1. The overall mortality in ICU was52.6%.Mortality in patients with AKI of KDIGO phase Ⅰ、phase Ⅱ and phaseⅢ were respectively31.2%,47.1%and70.8%.The mortality differences between the three groups were statistically significant (P<0.05).2. With the increase of KDIGO staging,The APACHEII score, SOFA score, the need for vasoactive drugs, the number of cases with oliguria and ICU mortality rate showed an increasing trend, the difference was statistically significant (p<0.05);3. After Multivariate analysis,independent risk factors of patients diagnosed with MODS complicated with AKI and underwent hemopurification treatment were as follows:the number of failed organs(OR=3.232,95%CI1.346～7.759), with oliguria (OR=5.307,95%CI1.085～25.946), the mean daily fluid balance is relatively positive (OR=1.003,95%CI1.001～1.006). Univariate analysis identified that KDIGO Ⅲ phase (OR=3.736,95%CI1.215～11.495), APACHEⅡ score (OR=1.145,95%CI1.054～1.244), and need of vasoactive agents (OR=3.967,95%CI1.314～11.970) were risk factors, too.Conclusion:1. The KDIGO classification plays an important role in predicting the prognosis of patients with MODS complicated with AKI in need of hemopurification treatment.2. The risk factors are the number of failed organs、with oliguria and the mean daily fluid balance relatively positive. Prevention and control of the risk factors may play an important role in the reduction of mortality of critically ill patients.