Clinical Study On Hospital-acquired Acute Kidney Injury Of Patients In Intensive Care Unit

Objective Acute kidney injury(AKI)is one of the most common complications of critically ill patients.AKI increases the mortality of Intensive Care Unit(ICU)inpatients,led to a burden to the health care.This study collected the clinical material of ICU inpatients with Hospital-acquired acute kidney injury(HA-AKI),research the clinical characteristics,then explore the morbidity?alternation of etiology,treatment measures and prognosis of HA-AKI in tertiary hospital's ICU.Primary discussion the risk factors of HA-AKI will improve the clinician's awareness of HA-AKI and take positive measures to prevent from the occurrence of HA-AKI.Methods:The research analyzes retrospectively critically ill patients with HA-AKI out of 1317 cases in ICU from January 1,2014 to December 31,2015,identified 188 cases under the standard of 2012 KDIGO(Kidney diseases: improving Global Outcomes)diagnostic criteria and staging criteria.Record the general condition,past medical history,clinical features,the relevant laboratory indexes(when admitted to hospital/ICU and the HA-AKI's occurrence)and prognosis(The study endpoint is hospital discharge or hospital death).According to their prognosis,the patients with HA-AKI were divided into the death group,renal function partial recovery group and fully recovery group.The patients' clinical datum before and after HA-AKI were compared between the renal function fully recovery group and the death group.Normal distribution data was indicated by?X±S,used two independent sample T-test.Nonnormal distribution data was indicated by median(P25,P75)and used two independent sample rank sum test.Enumeration data was indicated by ratio or proportion,the comparison of the datum in two groups was conducted by using ?2 test,the correlation analysis between two factors used linear correlation analysis,the analysis of multi-factors used logistic regression analysis.All datum was analyzed by statistical software SPSS 17.0.Results:1.There were 188 HA-AKI cases meet the standards of inclusion criteria in Two years,the incidence was 14.27%(188/1317),which composed by stage AKI 1 group(n =103,54.79%),AKI 2 group(n=35,18.61%),AKI stage 3 groups(n=50,26.60%);The higher AKI stage,the higher incidence with septic shock,the more number of organ failure,the higher utilization rate of mechanical ventilation,the higher vascular active drug utilization rate,and the higher APACHE(Acute physiology and ?chronic health evaluation ?)score(P<0.05);2.Infection(n=70,37.2%),traumatic disease(n=62,32.9%)and cerebrovascular accident(n=23,12.2%)were the top 3 in primary disease list.Etiological analysis by lesions: 86 cases was prerenal(45.7%),the main reason was traumatic hemorrhage,secondly was heart failure;95 cases were renal(50.6%),the main reason was sepsis(53cases,55.8%);postrenal were 7 cases(3.7%),the main cause were urinary calculi,peritoneo-pelvic neoplasms,etc.Etiological analysis by age: there were 77 cases of the younger group(age<60 years old),the main cause was renal AKI(accounted for 71.7%),elderly group(age?60 years old)include 111 cases,the main cause was prerenal AKI(accounted for 58.6%);the comparison of the datum in two groups showed the elderly group had the main cause of prerenal AKI,which was much different from the younger group which had the main cause of postrenal AKI(P<0.05).3.There were 87 death cases(mortality was 46.28%),which composed by stage AKI 1 group(n =36,34.9%),AKI 2 group(n=18,51.4%),AKI 3 groups(n=33,66.0%);The higher AKI stage,the higher mortality.The younger group's mortality rate is much lower than the elderly group(n=24,31.2% vs n=63,56.8%,P<0.01).4.The mortality risk factors of HA-AK: APACHE ?score>20 points(?2=14.6431,P<0.01),age(?60 years old)(?2=3.4571,P < 0.05),sepsis shock(?2=21.3214,P < 0.01),the number of organ failure>2(?2=17.5710,P<0.01)mechanical ventilation(?2=23.6574,P < 0.01),low blood pressure(?2=30.5709,P < 0.01).5.Independent risk factors for ICU patients complicated with HA-AKI: mechanical ventilation,sepsis shock.Conclusion: The Hospital-acquired acute kidney injury has much higher morbidity and mortality among intensive care unit patients,Infection,traumatic diseaseand cerebrovascular accident were the top 3 in primary diseases list.The prognosis of patients with HA-AKI is related with the AKI stage and the age of patient;the mortality was higher when the patients had higher AKI stage,and the elder patients had the much higher mortality.Age(?60 years old),sepsis shock,APACHE score(? >20 points),the utilization of mechanical ventilation,low blood pressure,the number of organ failure(> 2)are related with HA-AKI's prognosis.Mechanical ventilation,sepsis shock are the independent risk factors for the development of HA-AKI.