The Analysis Of Death Factors Of Acute Kidney Injury Caused By Scrub Typhus

Objective: To discuss the epidemiology,clinical characteristics,diagnosis and treatment measures,complications and prognosis of scrub typhus AKI in Guangxi,look for the death factors.Compare different stages of scrub typhus AKI,and look for prognostic factors.Methods: Retrospective study the complete clinical data of 81 patients with scrub typhus AKI from June 2012 to December 2018 in the first affiliated hospital of Guangxi medical university.According to the prognosis,the patients were divided into the survival group.The clinical features,examinations,treatment measures,complications were analyzed.Statistical methods were used to process the data,and P < 0.05 was considered statistically significant.Results:(1)The incidence rate of scrub typhus AKI in some parts of Guangxi was 25.47%,which was in the middle level of domestic(10.75%)and foreign(35.80%).The mortality rate was 17.28%,higher than that of domestic(15.15%)and foreign(16.10%).The survival rate was 82.72%,lower than that foreign(83.9%).The regional distribution decreases gradually from northwest to southeast by longitude.Signs of liver,spleen and lymph node enlargement is low,compared with the survival group,the non-survival group has a faster pulse rate,except contact,the rale,yellow dye,edema rate is higher.(2)The indexes of Urea,Creatinine,Cystatin C,PT and INR in the non-survival group were higher than the survival group,while the indexes of bicarbonate,LD1 and FIB were lower than the survival group(P<0.05).Renal function indicators and INR were different in different stages of AKI,it may be the prognostic biomarkers of the disease and correlated with the risk factors of death.High WBC,low Hb and Plt,low protein,and liver enzyme abnormalities were not the death factors of patients.(3)Patients with scrub typhus AKI need advanced life support therapy,such as ICU,ventilator support,vasoactive drugs,and sedatives,and the non-survival group is higher than the survival group(P<0.05).Among them,intensive care(49.38%),ventilator support(29.63%),and hemodialysis(16.05%)were all higher than foreign.The higher AKI stage,the higher the proportion of rescue measures,hemodialysis and plasma transfusion needed(P<0.05).(4)The complications of lung(96.29%),blood(76.54%)and liver(72.84%)damage were higher than foreign.The incidence of MODS(69.14%),shock(24.69%),cardiac arrest(9.88%)and brain damage(16.05%)was higher in the non-survival group than in the survival group(P<0.05).There was no difference in the incidence of above complications in different stages of AKI(P>0.05).(5)The results of regression analysis showed that shock complications(OR=5.185,95%CI=1.020-26.350)occurred in patients with scrub typhus complicated with AKI,requiring ventilator support(OR=12.162,95%CI=2.035-72.700)and abnormal coagulation and requiring plasma transfusion(OR=5.937,95%CI=1.206-29.234)therapy were risk factors for death.The duration of ventilator use in the non-survival group was longer than that in the survival group(P < 0.05).Conclusion:1.Compared with the level at home and abroad,the incidence of scrub typhus complicated with AKI in some parts of Guangxi is at the medium level,with higher mortality and lower survival rate.2.The clinical complications of shock,the need for ventilator support and the need for plasma transfusion were the risk factors for death.3.Urea,Creatinine,Cystatin C,PT,INR and FIB can be used as prognostic factors.