The Analysis Of Pathogeny And Prognostic Risk Factors Of Septic Patients Complicated With Acute Renal Injury In ICU

Objective: To identify and verify the related risk factors and outcome of sepsis complicated acute kidney injury(AKI) in intensive care unit(ICU). By predicting the related risk factors and outcome of patients with sepsis complicated acute kidney injury had been able to take the early interventional measures in treatment. Finally, the morbidity and mortality of patients with sepsis complicated acute kidney injury were reduced.Methods:We retrospectively collected and analyzed data of patients with sepsis in the ICU from February 2012 to December 2014. The related risk factors of sepsis complicated acute kidney injury and potential risk factors that could affected the mortality were collected to conduct by the single variable risk factors analysis and multivariate logistic regression analysis, and the independent risk factors were identified.Then the receiver operating characteristic(ROC) curve was used to assess the sensitivity, specificity, cut-off value and confidence interval(CI) of related risk factors. In the end, Drawn survival curve of patients with septic AKI with treated CRRT versus patients without treated CRRT to compared the length of survival.Results:1.A total of 166 patients with sepsis were enrolled, 95 with septic AKI and 71 with sepsis patients without developing AKI.What’s more, the septic AKI classified into two groups depended on outcome of 28 days, 33(34.8%) were composed of survivors’ group and 62(65.2%)were composed of non-survivors’ group. 2.By comparing and analyzing 71 patients with sepsis and 95 patients with sepsiscomplicated AKI, we found out Single factor analysis showed that the risk factors of serum K(t=-3.19, P=0.002),HCO3-score(t=3.01,P=0.003),APACHEⅡscore(t=-3.96, P<0.001),SAPSⅡscore(t=-5.12, P<0.001), Classification of sepsis(χ2=81.34, P<0.001),PCT(z=-1.51, P=0.02)had statistical significance. In multivariable regression analysis, independent risk factors for AKI included APACHEⅡscore(OR=1.084, 95%CI: 1.012-1.163, P=0.022), SAPS score(Ⅱ OR=1.117, 95%CI: 1.052-1.187, P<0.001), MAP(OR=1.07, 95%CI:1.002-1.133, P=0.04), Classification of sepsis(OR=2.92, 95%CI: 1.333-6.389, P=0.007). The ROC curve of SAPS Ⅱscore,APACHEⅡscore for patients with septic AKI or not respective is AUC 0.72(95%CI: 0.65-0.80)、AUC 0.61(95%CI : 0.61-0.77). 3.By comparing datas of 33 survivors with 62 nonsurvivors in patients with sepsis complicated with AKI, we found out Single factor analysis showed that the septic AKI was prognostic factors associated with survival of age(t=2.801,P=0.006),albumin(t=-2.95, P=0.004),serum K(t=4.11, P<0.001),CRP(t=-2.53, P=0.01),MAP(t=-6.32, P<0.001), APACHEⅡscore(t=6.24,P<0.001), Classification of sepsis(χ2=0.04, P<0.001), Mechanical ventilation(χ2=20.31, P<0.001), Organ dysfunction≥2(χ2=8.64, P=0.003), LDH(Z=-2.25, P=0.02) had statistical significance(P<0.05). In multivariable regression analysis, independent risk factors for prognostic factors associated with survival included Mechanical ventilation(OR=0.029,95%CI: 0.001-0.935, P=0.046), Organ dysfunction(OR=0.01, 95%CI: 0-0.443, P=0.018), MAP(OR=0.215, 95%CI: 1.032-1.430, P=0.02), serum K(OR=0.119, 95%CI:0.015-0.912, P=0.04), albumin(OR=1.4, 95%CI: 1.02-1.921, P=0.04),APACHE scoreⅡ(OR=0.789, 95%CI: 0.629-0.991, P=0.042).The ROC curve of APACHEⅡscore for patients with septic AKI predicted death is AUC0.87(95%CI: 0.78-0.95).survival curve of patients with septic AKI with treated CRRT higher than without treated CRRT,but had not statistically significant.Conclusion:1.urine output, APACHEⅡscore,SAPS score,MAP,Classification of Ⅱsepsis are independent risk factors for AKI,and SAPA score is better for predicting ⅡAKI than APACHEⅡ. 2.Mechanical ventilation,Organ dysfunction,MAP,serum K,albumin, APACHEⅡ score is independent risk factors associated with mortality. CRRT treatment is not statistical significance in prolong the survival time for patients septic AKI.