| Abstract:Objective:To study the risk factors of bee sting resulting in acute kidney injury (AKI) and the related factors affecting the prognosis of patients with AKI due to bee sting, to provide relevant evidences for clinic, so as to more effectively improve the success rate of treatment for patients with AKI due to bee sting. Methods:Adopt retrospective survey method, to collect clinical data about the patients with bee sting received and treated by Luzhou Medical College’s affiliated hospital from September 2003 to September 2013. According to the need of study, design the "clinical data record of patients with bee sting", collect the relevant content of the original case data about the patients with bee sting with a unified form, the main contents include:gender, age, time interval from bee sting to admission to the hospital, total hospitalization days, bee/bees sting, clinical manifestation, score of sequential organ failure assessment (SOFA) in the first 24 hours after admission and auxiliary examination (including blood routine examination, electrolyte, liver function, renal function, blood lipid, myocardial injury markers and blood coagulation function), treatment, prognosis, set up database and the data adopts SPSS 17.0 statistical software for statistical processing. Results:1. General condition of the patients with bee sting:from September 2003-September 2013, there are totally 150 cases of patients with bee sting received by Luzhou Medical School Affiliated Hospital, of which 91 cases conformed to the inclusion criteria, including 34 cases of female and 57 cases of male, the median and interquartile range of the patient’s age is 39 (12,59). Number of patients with bee sting shows a gradually increased trend while the mortality due to bee sting is declining.2. Situation of patients with MODS and AKI due to bee sting: (1) involved organs of patients with MODS:among 91 cases of patients with bee sting, there are 23 cases of patients with MODS, the involved organs in the order are respectively:23 cases of liver,19 cases of kidney,12 cases of blood coagulation system,6 cases of circulatory system and 6 cases of respiratory system. (2) Condition of the AKI patients with MODS:among 91 patients with bee sting, there are totally 21 cases with AKI,19 cases (90.5%)of patients with MODS and 2 cases(9.5%) of patients without MODS. (3) Conditions of patients with AKI and MODS and prognosis:there are 19 cases of AKI patient with MODS, of which 8 cases was cured and 11 cases died; 2 cases of patients not associated with MODS, of which 1 case was cured and 1 case died; 4 cases of MODS without AKI,3 cases were cured and 1 case died; 66 cases without AKI or MODS, of which 65 cases were cured and 1 case died. (4) Number of the organs of AKI patients with MODS and the prognosis:19 cases of AKI patients with MODS:3 cases with 2 failure organs; of which 2 cases were cured and 1 case died; 13 cases with 3 failure organs, of which 6 cases were cured and 7 cases died;3 cases with 4 failure organs and all died.3. Comparison between patients with AKI and patients with non AKI due to bee sting:(1) comparison of the general situation:there is no statistical difference in the gender of the patients with AKJ and patients with non AKI due to bee sting. The median and inter-quartile range of the AKI group’s age is 48.5 (34.8,65.3) and that of the non AKI group is 38.5 (12.0,52.0), and both are statistically significant (P< 0.05); the median and inter-quartile range of the two groups’time interval from bee sting to admission to the hospital is 24 (10,84) hours, that of the non AKI group is 5 (3,9) hours and both are statistically significant (P< 0.001); the median and inter-quartile range of the AKI group’s admission time is 7.5 (2.3,17.5) days and that of the non AKI group is 3 (2,5) days, both groups are statistically significant (P< 0.05); the mortality rate of the AKI group is 57.1%; that of the non AKI group is 2.9%, comparing the two groups, P< 0.01, so the two groups are statistically significant in the mortality rate. (2) Comparison of MODS situation:the incidence of MODS of the AKI group is 90.5%; that of the non AKI group is 5.7%; Comparison of two groups’incidence of MODS is P<0.001, the two groups are statistically significant; the average score of SOFA of the patients with MODS in the AKI group is 7.9±2.5 points and that of the acute kidney injury group is 3.3±1.5 points, comparison of two groups is P< 0.05, so the average score difference of SOFA of the patients with MODS is statistically significant. (3) Auxiliary examination results comparison:within 24 hous after the AKI group and non AKI group’s admission in the hospital, in the comparison of white blood cell count (WBC), hemoglobin (HB), kalium (K*), carbon dioxide (CO2) adhesive force, UREA, creatinine (CRE), alanine aminotransferase (ALT), aspertate aminotransferase (AST), total bilirubin (TBIL), total cholesterol (TC), triglyceride (TG), TnI-U1, creatine kinase MB subtypes (CK -MB), prothrombin time (PT), activated partial thrombin time (APTT) (P< 0.05), the difference has statistical significance. (4) Multi-factor Logistic regression analysis:the results show that the bee sting patients’age> 55, time interval from bee sting to admission to the hospital>6 hours, number of white blood cell>20×109/L and anemia are independent risk factors for AKI after the bee sting (P< 0.05).4. The situation of the cured group and the death group of patients with AKI due to bee sting:(1) general situation:the average age of the cured group of patients with AKI is 30.1±20.6 and that of the death group is 56.1±18.6; the median and interquartile range of the time interval from bee sting to admission to the hospital of the cured group of patients with AKI is 11.0 (5.5,36.8) hours and that of the 36.0 (20.0,144.0) hours; the median and interquartile range of the admission days of the AKI cured group is 16.0 (10.5, 23.5) days and that of the death group is 3.0 (1.0,5.0) days. (2) Situation of MODS:the incidence of MODS of the AKI cured group is 88.9%and that of the AKI death group is 91.7%; average score of SOFA of AKI cured group is 6.2±1.9 and that of death group is 9.2±2.3. (3) Auxiliary examination results:in the first 24 hours after the admission of the AKI cured group and death group into the hospital, the white blood cell count (WBC), hemoglobin (HB), kalium (K+), carbon dioxide (CO2) adhesive force, UREA, creatinine (CRE), alanine aminotransferase (ALT), aspertate aminotransferase (AST), total bilirubin (TBIL), total cholesterol (TC), triglyceride (TG), TnI-Ul, creatine kinase MB subtypes (CK -MB), prothrombin time (PT) and activated partial thrombin time (APTT) are all significantly abnormal. Conclusion:1. The age of patients with bee sting>55, time interval from bee sting to admission to the hospital>6 hours, number of white blood cell>20×109/L, anemia is an independent risk factor for acute kidney injury occuring after bee sting.2. Age, treatment time, number of MODS failure organs, SOFA score level could be poor prognostic factors of AKI patients caused by bee sting. |
PDF Full Text Request