Study On Risk Factors Of Acute Kidney Injury In Critically Neurological Patients

Objective Acute kidney injury?AKI?is one of the common complications of patients with severe neurological disease.Acute brain injury and acute kidney injury are mutually causal,leading to further aggravation of the disease.This study explored the risk factors for AKI in patients with severe neurological disease,and explored the factors that influence the prognosis of patients.Methods The clinical data of 207 patients with critically neurological disease were analyzed retrospectively,from Jan.2016 to Mar.2017 in the department of intensive care unit of Anhui Provincial Hospital Affiliated to Anhui Medical University?South District?.All patients were assigned into AKI group?40 cases?,non-AKI group?167cases?.According to the prognosis,the patients with AKI were divided into the survival subgroup?14 cases?and the death subgroup?26 cases?.Clinical risk factors,such as Glasgow coma scale?GCS?,acute physiology and chronic health status II?APACHEII?,blood glucose,white blood cell count?WBC?,central venous pressure?CVP?,blood sodium,Cystatin C,blood urea nitrogen?BUN?,and the proportion of patients using glycerol fructose or furosemide,were collected before the patient developed AKI.The statistically significant risk factors of AKI found by nivariate analysis were selected and analyzed to find independent risk factors in AKI patients with multivariate logistic regression analysis.Receiver operating characteristic curve?ROC?was drawn to assess the predictive value of blood glucose and CysC in patients with AKI.Results The incidence of AKI was 19.3%in the critically neurological patients.The hospital mortality in the patients with AKI was 65.0%,which was significantly higher than that in the non-AKI patients?P<0.01?.Compared with non-AKI patients,GCS?score:4.44±1.65 vs.5.39±1.62?,CVP[cmH2O?1cmH₂O=0.098kPa?:7.69±2.66 vs.8.98±2.56]were lower in patients at admission with AKI,APACHE II?score:24.50±3.67vs.20.05±4.42?,blood glucose?mmol/L:12.33±6.53 vs.9.33±3.26?,serum sodium?mmol/L:144.75±10.85 vs.140.58±5.23?,WBC?×10⁹/L:16.15±6.25 vs.12.79±4.22?,Cystatin C?mg/L:1.27±0.74 vs.0.74±0.26?and BUN?mmol/L:7.81±3.33 vs.5.53±3.20?significantly increased in AKI group,proportion of male?77.5%vs.59.9%?,patients with the comorbidity of hypotension?37.5%vs.19.8%?,use of glycerin fructose?17.5%vs.3.6%?,or use of furosemide?70.0%vs.13.8%?were more as compared with those in non-AKI group.There was a statistically significant difference between the above two groups?all P<0.05?,and others were not.The hyperglycemia[odds ratio?OR?=1.201,95%confidence interval?95%CI?=1.01¹.42,P<0.05]and use of furosemide?OR=24.493,95%CI=4.92¹20.36,P<0.01?were the independent risk factors for AKI by the multivariate logistic regression analysis.It was shown by ROC curve analysis that the area under the ROC curve?AUC?of blood glucosewas 0.733,which suggesting that blood glucose had certain predictive value,when the optimal cut-off value of blood glucose was 9.050mmol/L,the sensitivity was 77.5%and the specificity was 62.6%.ROC curve analysis also showed that CysC had certain predictive value,under the ROC curve?AUC?was 0.779,the cut-off was0.835 mg/L,the sensitivity was 75.0%%,the specificity was 67.9%?all P<0.05?.Compared with the survival subgroup in the patients with AKI,the GCS was lower?score:3.77±0.87 vs.5.50±2.03?at admission,but their serum glucose?mmol/L:16.51±9.10 vs.10.09±2.89?and BUN?mmol/L:10.26±3.07vs.6.48±2.70?were higher in the death subgroup with statistical differences?all P<0.05?.Conclusion1.AKI is one of the common complications in critically neurological patients.2.The independent risk factors of AKI are hyperglycemia and the use of furosemide,blood glucose had moderate predictive value.3.Cystatin C has moderate predictive efficacy in the diagnosis of AKI,but is not superior to SCr.4.Patients with severe brain injury,obvious stress response and high catabolism had higher mortality in hospital.