| Background and objective Acute kidney injury(AKI)is one of the common critical illnesses and the common complication among inpatients,which is characterized by acute onset,rapid progression and high mortality.Few clinical studies have been reported regarding AKI in elderly both at home and abroad.At present,serum creatinine(SCr)remains the gold standard to diagnose AKI,but research verifies that it is hysteretic.Once AKI is confirmed,no specific treatment is available in clinic.As a result,the prevention of AKI has become the focus of clinical work currently.This study aimed to analyze the clinical features and prognosis-related risk factors among the AKI patients,and to screen the AKI markers of AKI from the patients who took Cardial Surgery,so as to guide the screening of the AKI high-risk population,to instruct the clinical prevention of AKI,and improve the poor prognosis for AKI.Methods 1.Inpatients with hospital acquired-AKI(HA-AKI)were screened using the clinical information system of our hospital in accordance with the AKI diagnosis and classification criteria defined by KDIGO in 2012.Patients with CKD-5,or those receiving maintenance dialysis,kidney transplantation,and nephrectomy,or those with the admission time of<48 h,were excluded from this study.The clinical features of AKI patients,such as stage,etiology,department distribution,missed diagnosis rate and prognosis,were analyzed;moreover,the risk factors that affected the treatment withdrawal and death in the AKI patients were also analyzed using the logistic multivariate regression analysis.2.Inpatients aged ≥60 were also selected from the Cardial Surgery from October 2017 to October 2018.In addition,the residual blood and residual urine specimens of patients were collected within 48 h after admission in the Laboratory Medicine Department of our hospital.Apart from the above exclusion criteria,patients with preoperative oliguria,post-renal obstruction and those requiring emergency surgery were also excluded.6 respective cases from case group and controlgroup were detected using the protein chip Raybiotech kit,and the proteins would be screened.Moreover,the above-mentioned inter-group differential proteins would be performed by enlarged sample verification using Enzyme linked immunosorbent assay(ELISA),and ROC curve analysis was also carried out,so as to further determine its value in predicting AKI.Results 1.A total of 452 inpatients were finally enrolled into this study,the average age of the HA-AKI patients was 73.1±9.3 years,and the male-to-female ratio was 1.5:1.Most AKI patients were at stage Ⅰ and Ⅱ.With regard to the AKI etiology,the prerenal,renal and post-renal AKI had accounted for 61.3%,34.1%and 4.6%,respectively.Department distribution suggested that,the constituent ratios of Surgery,Internal Medicine and ICU were 40.3%,34%and 26%,AKI patients attending the Department of Nephrology accounted for only 3.1%of the hospital.In terms of the complications,the top three complications among the AKI patients were hypertension,coronary heart disease(CHD)and chronic kidney disease(CKD),which had taken up 66.2%,55.3%and 50%,respectively.The highest missed diagnosis rate of AKI(87.91%)was achieved in Surgery.There were 28 cases of renal replacement therapy during hospitalization.Patients discharged after recovery accounted for 76.5%,the mortality took up 13.1%,and 10.4%had given up the treatment.Only 28.8%patients had complete recovery of renal function at the time of discharge,while 55.3%had not recovered.During the length of stay,28 patients had received dialysis treatment.Age(OR=1.049,95%CI 1.008,1.092),infection(OR=2.263,95%CI 1.105,4.635),use of diuretics(OR=4.143,95%CI 1.003,17.114),AKI stage 2(OR=2.743,95%CI 1.159,6.492),AKI stage 3(OR=4.247,95%CI 1.268,14.219),and number of extra-renal failure organs(OR=4.259,95%CI 2.935,6.182)were the independent risk factors of in inhospital deaths and treatment withdrawal among the HA-AKI patients.2.In this study,urine samples of 6 cases of AKI and non-AKI from Cardial Surgery were screened through protein chip high through-put,and there were 87 differential proteins with the average difference of>5-fold,which was statistically significant(P<0.05).Compared with the control group,86 expression factors were elevated in the case group,while 1 were reduced(P<0.05).Four kinds of proteins were selected and the results of the microarray were verified by ELISA.Sixty cases were selected by ELISA for expanded sample verification.It was discovered that among the clinical data,the eGFR was statistically significant between AKI group and control group(69.99 ± 18.71 vs 79.59±13.34 ml/min/1.73m2,p<0.05).The urine supernatant clusterin level in AKI group was higher than that in control group(6.504±4.446 vs 3.702±3.904 ng/μmol,p<0.05).The areas under the ROC curve(AUC)of clusterin,eGFR,clusterin+eGFR in predicting postoperative AKI were 0.706,0.642 and 0.724,respectively.Conclusions 1.In our study,the single-center HA-AKI patients are mostly distributed in the departments other than the department of Kidney;mea:nwhile,the missed diagnosis rate is the highest in the department of Surgery;and over a half of patients are combined with hypertension,CHD and CKD.Age,combined infection,use of diuretics,increased number of extra-renal failing organs,and AKI stage are the independent risk factors of death and treatment withdrawal in HA-AKI patients.2.Protein microarray and ELISA were used to detect the clusterin protein in urinary supermatant as a biomarker for early warning of AKI.The area under the ROC curve was greater than 0.7,which has good accuracy and can be used to identify elderly people with high risk of AKI,longer sample are needed to further verify.Verify its clinical value. |
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