The Epidemiology Of Acute Kidney Injury In Critically Ill Patients In Gansu Province

Objective: To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in Gansu Province.In order to further understand the epidemiology of critically ill patients with AKI in the western region and even the whole country,it will lay a preliminary theoretical foundation.At the same time,it will provide a theoretical basis for early identification and intervention of risk factors related to death,improvement of poor prognosis,and further improvement of rescue success rate.Methods: Multicenter,retrospective study.The clinical data of all patients from January 1,2016 to December 31,2017 in the selected hospital intensive care department were screened.The inclusion criterias were 18 years of age or above,with complete admission and discharge records,the length of ICU stay for more than 24hours;the first diagnosis and initially treated.The exclusion criterias were chronic kidney disease,nephrectomy,kidney transplantation within 3 months before admission to ICU,re-admission to the ICU during the same hospitalization period and lack of basic data required by the study.In the end,patients with AKI were selected according to the AKI diagnostic criteria issued by the Kidney Disease: Improving Global Outcomes(KDIGO)in March 2012,and the epidemiological related clinical data and laboratory indicators of the above patients were collected.Descriptive statistical analysis was performed first,and then patients were based on survival status at discharge was divided into survival group and death group.Univariate and multivariate logistic regression analysis were used to determine the risk factors for in-hospital death in patients with AKI.Results:(1)Among the 8106 patients admitted,a total of 3019 patients were excluded according to the exclusion criteria and rejection criteria.Among the included patients,890 patients met the diagnostic criteria for AKI,with a morbidity rate of17.5% and a mortality rate of 41.3%.Male patients accounted for 68.2% of the cases,and the average age of AKI patients was 57±18 years old.The age group of 40-79 years old was the high-risk group of critically ill patients with AKI.The distribution of etiology of acute kidney injury accounted for 64% of pre-renal,33% of renal,and2.7% of post-renal.Pre-renal AKI is the most common cause,among which those caused by sepsis and septic shock accounted for 44.7%.among the selected AKI patients,AKI I accounted for 22.02%,AKI II accounted for 31.01%,AKI III accounted for 46.97%,and renal replacement therapy accounted for 35.8%.The higher the AKI stage,the higher the percentage of renal replacement therapy.(2)Logistic regression analysis showed that: male,age,AKI stage,RRT treatment,infection,post-cardiopulmonary resuscitation,low cardiac output,mechanical ventilation,diuretics,white blood cells,platelets,blood urea nitrogen,prothrombin time and activated partial thromboplastin time were significantly associated with prognosis of acute kidney injury(all P <0.05).Further analysis showed that male,age,AKI stage,RRT treatment,low cardiac output,mechanical ventilation,increased leukocyte count,decreased platelet count and serum albumin reduction were independent risk factors for prognosis of acute kidney injury.Conclusions:(1)Large epidemiological data from several representative hospitals in Gansu Province show that the incidence and mortality of acute kidney injury in the Intensive Care Unit is still high,and the higher the stage,the worse the prognosis;Advanced age is still a risk factor for the increased development and mortality of AKI in critically ill patients.Sepsis and septic shock are the main causes of AKI.(2)In addition to the current common and intuitive risk factors,leukocyte counts,platelet counts,and albumin levels in laboratory indicators are predictors of in-hospital death in critically ill patients with AKI.