To Analyze The Risk Factors Of Sepsis Complicated With AKI And Readmission Within 30 Days

ObjectiveTo analyze the characteristics of sepsis,the morbidity,mortality,readmission rate and clinical characteristics of sepsis complicated with acute kidney injury(AKI),and the associated risk factors of AKI.MethodsWe retrospectively analyzed the sepsis patients admitted to intensive care unit(ICU)from July 1,2015 to June 30,2016 in the Third Central Hospital of Tianjin.All patients met the diagnostic criteria set out in the International Guidelines for the Treatment of Severe Sepsis and Sepsis Shock in 2012.191 effective cases were selected.The end of the observation period was the day of death or 30 days after discharge.Data were recorded by viewing patient records and telephone follow-up.Routine data include gender,age,past history,treatment,re-admission and so on.Laboratory items include blood gas analysis,blood,liver function,renal function,blood lipids,coagulation,myocardial enzymes,B-type natriuretic peptide,C-reactive protein,plasma procalcitonin and so on.The worst results were recorded within 24 hours after diagnosis of sepsis or severe sepsis.The patients were divided into AKI group and non-AKI group according to whether they had AKI or not.The differences of the two groups were compared.Multivariate logistic regression analysis was performed to identify the risk factors for sepsis complicated with AKI.All patients in the AKI group were divided into CRRT intervention group and routine treatment group,and the differences between the two groups were analyzed to determine the effectiveness of CRRT in patients with sepsis with AKI.Finally,patients who were re-hospitalized within 30 days were analyzed.ResultsOf the 191 patients with sepsis,155(81.15%)were more than 60 years old.Respiratory tract was the major site of sepsis(57.1%).Gram-negative bacteria as the main pathogens(56.8%).94 cases of sepsis complicated with AKI accounted for 49.2%.The incidence of AKI was 4.7% in common sepsis and 62.2% in severe sepsis.The probability of occurrence of AKI in severe sepsis was significantly higher than that of normal sepsis,and the difference was statistically significant(?~2 = 44.093 P <0.05).A total of 81 deaths were reported in all patients,with a total mortality rate of 42.4% for sepsis.The death rate was 53.2% in the AKI group and 32.0% in the non-AKI group.The mortality of AKI group was higher than that of non-AKI group,and the difference was statistically significant(?~2 = 8.812 P <0.05).Comparison of count data between two groups of data: The proportion of diabetic patients in AKI group(50.0%)was significantly higher than that in non-AKI group(22.7%),and the difference was statistically significant(?~2 = 15.441 P <0.05).The rate of continuous renal replacement therapy(CRRT)was significantly higher in AKI group(46.8%)than that in non-AKI group(27.8%),and the difference was statistically significant(?~2 = 7.358 P <0.05).However,there were no statistically significant differences in place of residence,gender,ventilator utilization,past hypertension and coronary heart disease.Comparison of measurement data: There were significant differences between the two groups in age(T = 2.709 P <0.05),mean arterial pressure(T =-5.516 P <0.05),lactate(Z =-5.319 P <0.05),arterial blood pH(T =-3.524 P <0.05)),Platelets(T =-3.524 P <0.05),albumin(T =-4.277 P <0.05),prothrombin time(Z =-6.071 P <0.05),Plasma procalcitonin(Z =-5.904 P <0.05),APACHE ? score(T = 7.147 P <0.05).The age,prothrombin time(PT),plasma procalcitonin(PCT),lactic acid(Lac)and acute physiological chronic health score(APACHE?)were higher in the AKI group than in the non-AKI group.The values of arterial blood pH,mean arterial pressure(MAP),platelet count(PLT)and albumin(ALB)were lower in the AKI group than in the non-AKI group.There were no statistically significant differences in body temperature,heart rate,respiration,white blood cell count(WBC),hemoglobin(HGB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),activated partial thromboplastin time(APTT),triglyceride(TG),cholesterol(TC),High-density lipoprotein(HDL-C),B-type natriuretic peptide(BNP),C-reactive protein(CRP),length of stay in ICU,total length of stay.Multivariate logistic regression analysis showed that the risk factors for AKI were history of diabetes(OR = 3.096 P <0.05),high PCT(OR = 1.095 P <0.05),high APACHE ? score(OR = 1.244 P <0.05).Of the 94 patients with sepsis complicated with AKI,44 patients underwent CRRT intervention,14 died and 31.8% died.Fifty patients were treated with conventional therapy,36 died,72% mortality,and CRRT Lower than the conventional treatment group,and the difference between the two groups was statistically significant(?~2 = 15.177 P <0.05).The mechanical ventilation time(114.71 ± 15.765)in the CRRT group was significantly lower than that in the conventional treatment group(125.33 ± 16.223),and the difference between the two groups was statistically significant(T =-2.756 P <0.05).There was no statistically significant difference in hospital stay between the two groups.Suggesting that CRRT intervention can effectively improve the prognosis of patients with sepsis combined with AKI.A total of 110 patients were discharged from the hospital and 21 of them were re-admitted within 30 days.The total re-admission rate was 19.1%.Among the 110 discharged patients,8 patients were re-hospitalized in the non-AKI group,and the rate of readmission was 12.1%.In the AKI group,13 patients were re-hospitalized and 29.5% were re-admitted.The rate of readmission was higher in the AKI group than in the non-AKI group within 30 days after discharge,and the difference was statistically significant(?~2 = 5.189,P <0.05).The mean age of rehospitalization patients(70.38 ± 4.318)was significantly higher than that of non-rehospitalized patients(63.30 ± 14.158),and the difference was statistically significant(T = 3.994 P <0.05).Conclusion1.In the ICU,the incidence of sepsis is high,the mortality rate is high,the majority of elderly patients,the respiratory tract as the main site of infection,Gram-negative bacteria as the main pathogens.2.Sepsis prone to AKI,with AKI after a higher rate of re-admission and mortality.3.After sepsis complicated with AKI,there was more age,diabetes history,MAP lower,arterial blood pH lower,lower PLT,lower HGB,higher Lac,higher PCT,worse coagulation Function,a higher APACHE ? score,CRRT ratio is high.4.A history of diabetes,high APACHE ? score,high PCT is a risk factor for sepsis complicated with AKI.5.The implementation of CRRT intervention can effectively improve the prognosis of patients with sepsis combined with AKI.6.The mean age of patients re-admitted within 30 days was greater than that of non-rehospitalized patients.