Epidemiology And Analysis Of Risk Factors Associated With Acute Renal Injury Due To Bee Sting

Objective: Acute kidney injury(AKI)is one of the serious complications after the hymenoptera insects stings(Honey Bee,Wasp,Sphecidae,Scoliid et al.)which is associated with outcomes and the quality of life.A single central,retrospective study,collect the clinical information of patients with bee sting and build the databases.The bee sting patients with AKI epidemiology and analysis of the risk factors provide the basis for clinical decisions in future.Methods : Collecting and recording basic information,laboratory data within24 hours,hospitalization time,Intensive Care Unit(ICU)time,Multiple Organ Dysfunction Syndrome(MODS)and death of patients with bee sting,and build the databases between January 2014 and December2016 in Nanchong Central Hospital.The patients are divided into two groups according to whether have AKI:AKI group and non AKI group.Using univariate and multivariate Logistic regression analysis the risk factors of bee sting with AKI.Results: 1.203 hospitalized bee sting patients were investigated,164 patients conformed to the standard.The total mortality is 6.1%(n=10),the total incidence rate of MODS is 39.02%(n=64).The prevalence of AKI is 26.83 %(n=44),the mortality rate appeared as22.73%(n=10),the prevalence of MODS is88.64%.There was no death in non AKI group.2.The events of bee sting mainly occur in summer and autumn(August~October).21 cases of single bee sting(12.8%),56 cases of >10 stings multiple bee stings(34.15%).10 cases(0.61%)with hypotension(<90/60 mm Hg),and 15patients(9.15%)suffered shock.According to whether the patients have AKI,they are divided into AKI group[44(male 33,Female11)] and non AKI group[120(male 76,Female 44)].AKI group:16 patients(36.36%)with Hemoperfusion(HP),2 patients(4.55%)with Continuous Renal Replacement Therapy(CRRT),10 patients(22.73%)with CRRT+HP.Non AKI group :31patients(25.83%)with HP,1 patients(0.83%)with CRRT,2 patients(1.67%)with CRRT+HP,with statistically significant difference(P<0.05).AKI group blood purification replacement treatment time is6.95±10.61 hours,non AKI group is 1.08±3.69 hours,statistically significant difference(P<0.05).The hospitalization time of AKI group and non AKI group is12.11±12.71 days and4.08±2.69 days,respectively.The ICU time of AKI group and non AKI group is1.45±2.52 days and 0.12±0.66 days,respectively.3.Univariate Logistic regression analysis showed that AKI is associated with age,season,bee sting sites,the number of bee sting,hymenoptera species(honey bee,wasp,other,unknown species),MODS and whether use glucocorticoid before or within 24 hours during hospitalization(P<0.05).There was no significant association with gender,acute allergic reaction,history of past illness,the period of patients into hospital after bee sting,blood pressure and shock when patients into hospital(P>0.05).Univariate analysis also showed that AKI is associated with White Blood Cells(WBC),Haemoglobin(Hb),Potassium(K+),Calcium(Ca2+),liver and kidney function,Triglyceride(TG),myocardial enzymes,myocardial injury markers,Activated Partial Thromboplastin Time(APTT)and routine urine test,when patients into the hospital after 24 hours(P<0.05).4.Multivariate Logistic regression analysis showed that AKI is associated with age(OR=1.078,95%CI:1.034~1.124),the number of bee sting(OR=1.040,95%CI:1.009~1.072),MODS(OR=39.426,95%CI:9.155~169.791)whether use glucocorticoid before or within 24 hours during hospitalization(OR=3.431,95%CI;1.032~11.413),statistically significant(P<0.05).Using Logistic regression model to set unknown species as the reference to compare with other three types of hymenoptera species,showed that wasp is the independent risk factor of AKI(OR=17.840,95%CI: 5.475~ 58.158),statistically significant difference(P<0.05).5.Exclude laboratory indicators which have no statistically significant difference in univariate Logistic regression.Our study found that AKI is associated with WBC(OR=1.160,95%CI:1.070~1.259),High Sensitivity C-Reactive Protein(HSCRP)(OR=1.042,95%CI:1.011~1.074),Lactate Dehydrogenase(LDH)(OR=1.002,95%CI:1.001~1.003),Creatine Kinase Isoenzymes(CK-MB)(OR=1.015,95%CI:1.007~1.024),Myoglobin(MYO)(OR=1.001,95%CI:1.001~1.002),Alanine Aminotransferase(ALT)(OR=1.010,95%CI: 1.001~1.019),Aspartate Transaminase(AST)(OR=1.004,95%CI:1.001~1.007),K+(OR=2.339,95%CI:1.123~4.871),N-Termin al pro-B-type Natriuretic Peptide(NT-pro BNP)(OR=1.002,95%CI:1.001~1.003),Urine protein(OR=3.309,95%CI:1.406~7.789),statistically significant(P<0.05).Conclusion:1.The total mortality is 6.1%,the total incidence rate of MODS is39.02%.The prevalence of AKI is 26.83 %,the mortality rate appeared as22.73%,and the prevalence of MODS is 88.64%.Mainly in summer and autumn,most patients with multiple wasp stings.2.Age,the number of bee sting,wasp,MODS,and whether use glucocorticoid before or within 24 hours during hospitalization was the risk factor for AKI of patients with bee sting.3.The higher the degree of abnormal of WBC,HSCRP,LDH,CK-MB,MYO,ALT,AST,K+,NT-pro BNP and Urine protein are the higher the risk of AKI.4.The incidence of MODS,mortality,hospitalization time,ICU time,need for replacement therapy and the time required for replacement therapy in bee sting patients with AKI were significantly higher than non AKI.