A Study Of The Start Timing Of CRRT And Prognostic Risk Factors In Patients With Sepsis And AKI

Objective: To analyze the rising time of Cys C in patient with sepsis and acute kidney injury who was treated with CRRT. To evaluate the relationship between the interval and the prognosis, so as to find the optimal time to start the CRRT.Methods: We retrospective studied 65 patients with sepsis and acute kidney injury treated with continuous veno-venous hemofiltration (CVVH) in the period of January 2013 to January 2015. According to the interval,these patients were divided into three group: A group( < 48h), B group(48-72h), C group( > 72h). The relevant clinical presentations were compared among patients with three groups, such as in-hospital mortality, recovery rates of renal function, APACHE ? score, SOFA score, the number of failed organs, mean arterial pressure, and the laboratory index including serum creatinine, serum cystatin C, PLT, PH ect. Univariate and multivariate analysis were performed to identify risk factors associated with patients with sepsis and acute kidney injury.Results:1. The overall in-hospital mortality rate was 53.85%. The rate in A group was 44.83%, the rate in B group was 52.94%, the rate in C group was 68.42%.The in-hospital mortality rate showed no difference between three groups.2. The recovery rates of renal function in A group was 55.17%, the rate in B group was 29.41%, the rate in C group was 21.05%. The recovery rate of renal function was significantly higher in A group than in the other two groups(P < 0.05).3. The area under curve (AUC) of each staging group predicting mortality of septic AKI patients was 0.605. The AUC of APACHE ? score predicting mortality of septic AKI patients was 0.721. The AUC of SOFA score predicting mortality of septic AKI patients was 0.757. The AUC showed no difference between these three indexes.4. Binary classification unconditioned Logistic regression analysis showed that mechanical ventilation, the number of failed organs were independent risk factors of mortality for septic AKI patients.5. Binary classification unconditioned Logistic regression analysis showed SOFA score, the number of failed organs were independent risk factors of recovery of renal function for septic AKI patients.Conclusion:1. When Cys C rised within 48 hours, early implementation of CRRT treatment in septic AKI patients could increase the recovery rates of renal function.2. The number of failed organs, mechanical ventilation were independent risk factors of mortality for septic AKI patients.3. The number of failed organs, SOFA score were independent risk factors of recovery of renal function for septic AKI patients.