Investigation Of The Current Status Of Acute Kidney Injury In CCU Patients And TCM Syndrome Research

Objective:To investigate the incidence of Acute Kidney Injury(AKI)in the Coronary Care Unit(CCU)of Dongzhimen Hospital Beijing University of Chinese Medicine and the characteristics of TCM syndromes.Methods:A retrospective clinical study was performed.All patients admitted to the CCU of Dongzhimen Hospital Beijing University of Chinese Medicine from January 1,2015 to December 31,2015 were screened.The diagnosis of AKI is based on the criteria recommended by the KDIGO guidelines.The classification of TCM syndromes is based on the "National Standards of the People's Republic of China,which was issued in 1997" combined with the case data of CCU patients,the eight-class syndrome differentiation and blood and body fluid theory.Research includes:1 To study the occurrence of AKI in CCU patients;2 To study the demographic characteristics,clinical features,laboratory tests,treatment,clinical outcomes of CCU patients,and multivariate logistic regression was used to analyze the risk factors of AKI and death;3 To study the characteristics of TCM syndromes in patients of CCU.Results:1 186 cases were enrolled in total in this study.There were 65 cases(35.0%)of AKI.There were 49 cases(75.4%)in AKI 1 stage,13 cases(20.0%)in AKI 2 stage,and 3 cases(4.6%)in AKI 3 stage.Among them,50 cases(76.9%)were prerenal,8 cases(12.3%)were renal,1 case(1.5%)was postrenal,and 6 cases(9.2%)were unexplained.The diagnosis rate was 10.8%,and the missed diagnosis rate was 89.2%.2 ?Demographic data,clinical features and laboratory inspection:age,multiple organ failure,urea nitrogen and serum creatinine(Scr)were significantly higher in AKI group than in non-AKI group(P<0.001);Increased NT-proBNP,lower extremity edema,hypertension,hyperuricemia and admission eGFR<90ml/(min·1.73m2)were higher in AKI group than in non-AKI group(P<0.05).?Treatment:the use of diuretic was significantly higher in AKI group than in non-AKI group(P<0.001).?Multivariate logistic regression analysis showed that the use of diuretic(OR = 6.980),eGFR<90 ml/(min·1.73m2)(OR = 2.201),and non-renal multiple organ failure(OR = 3.733)were independent risk factors of AKI.?Univariate and multivariate analysis of mortality:age,multiple organ failure,and occurrence of AKI were significantly higher in death group than in non-death group(P<0.001);Hemoglobin was significantly lower in death group than in non-death group(P<0.001);Urea nitrogen was significantly higher in death group than in non-death group(P<0.001);Scr was higher in death group than in non-death group(P<0.05);Renal replacement treatment was significantly lower in death group than in non-death group(P<0.001);Admission eGFR<90ml/(mina·1.73m2)and the use of cardiac antagonism were higher in death group than in non-death group(P<0.05).Multivariate logistic regression results showed that the age>80 years old(OR=5.747)and the occurrence of AKI(OR =5.379)were independent risk factors for predicting death.?Outcomes:the hospital mortality and discharged Scr were significantly higher in AKI group than in non-AKI group(P<0.001);The number of hospital mortality and days in hospital were higher in eGFR<90ml/(min-1.73m2)group than in eGFR>90ml/(min·1.73m2)group(P<0.05).3 Symptoms of TCM:? Water retention syndrome was higher in AKI group than in non-AKI group(P<0.05).Among deficiency syndrome,the frequency of qi deficiency was the highest,followed by yin deficiency.Among excess syndrome,blood stagnation was the highest,followed by phlegm syndrome.The AKI group had the highest percentage of deficiency mingling with excess(50.8%).?Qi deficiency and water retention were higher in eGFR<90ml/(min·1.73m2)group than in eGFR?90ml/(min·1.73m2)group(P<0.05);The characteristics of deficiency syndrome and positive syndrome were the same as above.The eGFR<90 ml/(min·1.73m2)group had the highest percentage of deficiency mingling with excess(51.4%).Conclusion:The occurrence of AKI in CCU of Dongzhimen Hospital is featured with high incidence and rate of missed diagnosis.In clinical treatment,the use of high-dose diuretic should be careful,and pay more attention on the protection of the kidneys and other vital organs.We should pay attention to the treatment of heart and kidney simultaneously as well as biao and ben,mainly on tonifying the qi and nourishing the yin,activating blood to resolve stasis,concurrently excreting the water and eliminating the phlegm.