Risk Factors For Sepsis-associated Acute Kidney Injury In Children

Objective: To analyze the risk factors of Acute Kidney Injury(AKI)associated with sepsis in children,so as to provide basis for clinical prevention and early diagnosis of AKI.Methods: Children admitted to the first department of critical care medicine of hunan children's hospital from January 2018 to December 2018 and diagnosed with sepsis were collected.According to the KDIGO criteria for the diagnosis of AKI in children,AKI was divided into non-aki group with sepsis and AKI group with sepsis.According to the occurrence and degree of AKI,the patients were divided into the sepsis ak-1 stage group,AKI-2 stage group and AKI-3 stage group.General information,vital signs,urine volume,fluid volume,blood routine,liver and kidney function,and inflammatory index were collected retrospectively.Diagnosis and treatment process;Statistical analysis was performed according to the grouping of children.Result:1.General information: a total of 108 children who met the eligibility criteria were collected,including 62 males(57.4%)and 46 females(42.6%),with a male to female ratio of 1.35:1.Among them,52(48.1%)were younger than 1 year old,26(24.1%)were 1 to 3 years old,18(16.7%)were 3 to 6 years old,and 12(11.1%)were older than 6 years old.Among them,34 cases(31.5%)were diagnosed with AKI,among which 25 cases(73.5%)were male and 9 cases(26.5%)were female.Grouping: 74 patients(68.5%)in the Non-AKI group,5 patients(4.6%)in the AKI risk stage,17 patients(15.7%)in the AKI injury stage,and 12 patients(11.1%)in the AKI failure stage.Among them,49 cases(45.4%)needed invasive respiratory support therapy,and 23 cases(21.3%)needed non-invasive respiratory support therapy.Sixteen of them(14.8%)required renal replacement therapy.Among them,55 cases(50.9%)improved after treatment,and 53 cases(49.1%)had poor prognosis after treatment(including abandonment of treatment and death).2.clinical data: according to the symptoms of children admitted to hospital complaints analysis 108 cases of children with common symptoms,including fever,86 cases(79.6%),cough/breathing/shortness of breath,cyanosis,42 cases(38.9%),tic/disturbance of consciousness,sleepiness,20 cases(18.5%),diarrhea/vomiting/o 10 cases(9.3%),platelet reduce/two/three series 7 cases(6.5%),6 patients with jaundice(5.6%),oliguria/dark brown urine in 3 patients(2.8%);Of the 108 cases,42(38.9%)were diagnosed with pneumonia and severe pneumonia,and 20(18.5%)with intracranial infection,febrile convulsion and toxic encephalopathy.Other digestive tract,blood system and urinary system use relatively little change;Among the 108 cases,10(9.3%)were clinically diagnosed with haemophilus syndrome,and one of them was considered as EBV related haemophilus syndrome.Most of the 108 children were treated with multiple antibiotics during hospitalization,up to 8,with mean standard deviation of 3.12±1.85.The longest duration of antibiotic use was 69 days,and the mean standard deviation was 13.88±13.45 days.In 108 cases,all of them showed various degrees of organ function involvement,and the average number of organ injuries was 3.43±1.8.Within 24 hours after admission,the maximum amount of fluid was 2650 ml,and the mean standard deviation was 441.95±417.87 ml.3.comparison data set: the two groups of children with gender,age,mechanical ventilation,renal replacement therapy,prognosis,and routine blood leucocyte number(WBC),hemoglobin(HGB),neutrophils ratio(N),lymphocyte ratio(L),platelet(PLT)and blood c-reactive protein(CRP),calcitonin(PCT),blood lactic acid level and liver and kidney function,hospitalization duration,hospitalization expenses,types of antibiotics,acrylic ball usage,admitted to hospital 24 hours of liquid load,admitted to hospital 24 hours of SOFA score,number of organ involvement and other data for statistical analysis.It was suggested that gender,blood neutrophilic granulocyte ratio,lymphocyte ratio,procalcitonin level,blood urea nitrogen,24-hour fluid load after admission,and SOFA score had statistical significance with the occurrence of AKI.There was statistical significance between the occurrence of AKI and more organ dysfunction.Binary logistic regression analysis of relevant factors indicated that the risk of female children was lower than that of male children,with a ratio of 0.257.SOFA score after admission for each additional level,AKI occurrence(OR)2.349;For each level of 24-hour liquid load,AKI occurred at(OR)1.749.For each level of blood urea nitrogen,the incidence of AKI(OR)was 4.294.The constant value is-5.642.Gender,admission SOFA score,24-hour fluid load,blood urea nitrogen are independent risk factors for the occurrence of sepsis AKI.3.Four components is tip: will not AKI group compared with AKI periods between the four groups of tip: mechanical ventilation,blood neutrophils ratio(N),calcitonin(PCT),blood urea nitrogen(BUN),serum creatinine(Scr),admitted to hospital 24 hours of liquid load,admitted to hospital 24 hours of SOFA score,number of organ involvement was statistically difference between the four groups.There were differences in mechanical ventilation and gender between the two groups.conclusion Gender,fluid load within 24 hours after admission,SOFA score and blood urea nitrogen(BUN)within 24 hours after admission can be used as independent risk factors for predicting sepsis AKI.