Risk Factors And Clinical Early Warning Of Acute Kidney Injury In Patients With Sepsis

Object:To analyze the related risk factors of patients with acute kidney injury(AKI) induced by sepsis, and set up an equation for early diagnosing AKI induced by sepsis.Method:A retrospective review was carried out via clinical data in sepsis patients with/without acute kidney injury (AKI) from Binzhou medical college affiliated hospital intensive care unit from April 2011 to April 2013, in which 90 sepsis cases with AKI while 58 sepsis patients without AKI. The outcomes including age, application of mechanical ventilation, central venous pressure (CVP), mean arterial pressure (MAP) score, alanine transaminase (ALT), aspartate transaminase (AST), prothrombintime (PT), activated partial thromboplastin time (APTT), total bilirubin (TBIL), white blood cell (WBC), platelet (PLT), the sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, urine volume in 24 hours, net liquid intake in 24 hours score, serum creatinine (SCr) score, urea nitrogen, oxygenation index, arterial blood lactic acid score and albumin were measured. The data were analyzed by SPSS 17.0. Results of the measurement data were shown in x±s. T tests were used to examine the parameters between the two groups. X2 tests were used to compare the parameters of count data. By multiple linear regression analysis of clinical data, eventually, we get the regression equation for early diagnosing AKI induced by sepsis.Results:The alanine transaminase (ALT), total bilirubin (TBIL), mean arterial pressure (MAP) score, the sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,net liquid intake in 24 hours, serum creatinine (SCr) score, urea nitrogen, oxygenation index, arterial blood lactic acid score, urine volume in 24 hours, oxygenation index, albumin were correlated with AKI induced by sepsis.through the variable selection, SCr score, MAP score,arterial blood lactic acid score and net liquid intake in 24 hours score were included in the regression equation. Eventually,we got an equation:y=0.237X1+0.139X2+0.057X3+0.051X4(X1、X2、X3、X4 refers to serum creatinine score, MAP score, arterial blood lactic acid score, and the 24-hours net fluid input score, respectively) and the diagnostic cutoff appeared as 0.778. We carried out statistical tests for the equation and the results were as follows:the F statistics was 125.897,P=0.000, the diagnostic cutoff was 0.778,the sensitivity,the specificity,the Youden index, Positive Predictive Value and Negative Predictive Value were 80%,100%,0.8,100% and 74%,respectively.Conclusions:1.The main factors affecting the incidence of sepsis complicated by AKI may be associated with serum creatinine (SCr), fluid balance, mean arterial pressure (MAP), and arterial blood lactic acid.2.We got an equation for early diagnosing acute kidney injury induced by sepsis: y=0.237X1+0.139X2+0.057X3+0.051X4 (X1、X2、X3、X4 refers to serum creatinine score, MAP score, arterial blood lactic acid score, and the 24-hours net fluid input score, respectively).If the value of the clinical early warning equation is above 0.778,there will be the risk for occurring of AKI for sepsis patients.