The Study Of Risk Factors And Prognosis Of Patients With Septic AKI

Object To assess the incidence rate, risk factors and prognosis of patients with septic acute kidney injury.Data and methods This retrospective study involved 174 patients admitted to the emergency ward of Tianjin Medical University General Hospital from January to December 2013.The diagnosis fit the criteria made by SCCM/ACCP,2012.23 patients were excluded for under 18 years old,under 2 days,creatinine below two times,history of contrast agent. Data was recorded included age,sex,days in hospital,past history,creatinine,urea nitrogen,heart rates,urine volume,mean artery pressure, WBC accounts,usage of vasoactive agent and ventilator,PLT accounts,PCT value,blood sodium,blood potassium,p H,ALB,blood glucose etc. The SAPS score was calculated by the worst laboratory data. The outcome of patients was also recorded for prognosis.Results 1.Of 151 patients with sepsis,67(44.37%)patients developed AKI.2.2.Age76(28)vs70(21),preexisting diabetes mellitus53.73% vs32.14%,CHD58.20%vs34.52%,preexisting CKD22.38% vs5.95% of patients with AKI were higher than non-AKI patients(P<0.05).Gender had no statistic significance(P>0.05).Heart rates of patients with AKI were higher than patients with no AKI.,96(19) vs80(10)(P <0.05),and MAP was lower,88.43±14.84 mm Hg vs94.46±13.77 mm Hg(P <0.05).Rates of vasoactive agent and ventilator were higher than patients with no AKI,34.32% vs9.52%(P<0.05),31.34% vs14.28%(P<0.05).3.WBC,lactic acid,PCT,CRP of patients with AKI were higher than patients with no AKI.WBC 12.87(11.10)×109/Lvs11.77(7.08)×109/,lactic acid value 1.51(1.20)mmol/l vs1.45(0.37)mmol/l,PCT5.32(6.51)ng/mlvs3.46(5.70)ng/ml,CRP13.59±11.03mg/d vs3.11±8.71mg/d.PLT accounts,Na,ALB were lower PLT(156.19±100.17)×1012/L vs(192.52±106.78)×1012/L,Na129.27±5.52mmol/lvs133.00±5.67mmol/l,ALB30.55±6.78u/lvs30.85±5.57u/l.Blood potassium3.71±0.68mmol/l vs 3.62±0.62mmol/l and p H7.42±0.11vs7.45±0.69,had no statistic significance(P>0.05).4.SAPS score of patients with AKI was higher, 37.97±7.96vs33.17±6.64(P<0.05).5.High SAPS score(OR: 1.065, 95%CI: 1.009~1.123),low MAP(OR:0.971, 95% CI:0.946~0.997),high WBC(OR: 1.066, 95% CI: 1.013~1.123),low PLT(OR: 0.996, 95%CI:0.994~0.999),low Na(OR: 0.923,95% CI: 0.866-0.983),fast heart rates(OR:1.047,95% CI:1.007~1.088),preexisting diabetes mellitus(OR:3.561,95%CI:2.074~6.112),preexisting CKD(OR: 1.018, 95% CI:1.006~1.031) were related with the occurrence of AKI.Data of AUC showed diabetes mellitus 0.806,heart rats0.733,SAPS 0.701.high lactic acid(OR:0.372,95% CI: 0.172~0.806),preexisting diabetes mellitus(OR:0.563, 95% CI: 0.499~0.612),PCT(OR:0.292, 95% CI:0.164~0.516,P<0.05) were risk factors for the mortality of patients with AKI.6.Days in hospital had no statistic significance15.84±12.63 days vs15.95±7.96days(P>0.05),the mortality of patients with septic AKI were higher than patients with no AKI,,59.70%vs14.31%(P < 0.05).AKI(OR:7.407,95% CI:3.487~15.735,P <0.01)influenced the prognosis of septic patients,and was related with the death of patients.Conclusion 1.The incidence rate of septic AKI was high.2.older year,higher SAPS score,lower MAP,faster heart rates,higher WBC,PCT,lactic acid value,preexisting diabetes mellitus,preexisting CKD were related with AKI.3.Preexisting diabetes mellitus,high lactic acid value,high PCT were increased the mortality of patients with septic AKI.4.AKI influenced the prognosis of septic patients.