Clinical Retrospective Analysis Of Patients With Preeclampsia Complicated With Acute Kidney Injury

Background and objectiveAcute kidney injury(AKI)is one of the common complications in intensive care unit(ICU),and pregnancy is a common cause of pregnancy-related acute kidney injury(P-AKI).Preeclampsia is one of the leading-cause of P-AKI,especially in low-income and middle-income countries.But there are few studies on the incidence and mortality of P-AKI.Therefore,this study aims to evaluate the clinical and laboratory characteristics and related risk factors of P-AKI in patients with preeclampsia in ICU and the predictive value of related laboratory indicators of P-AKI.MethodsA retrospective analytical was conducted among 556 critically pregnant women who were admitted to ICU of Shandong Provincial Hospital from January 1st,2010 to December 31st,2018.According to the guidelines for diagnosis and treatment of hypertensive disorders of pregnancy(201 5)-preeclampsia criteria and the AKI diagnosis and Kidney Disease:Improving Global Outcomes(KDIGO)-AKI criteria.148 subjects were divided into two groups:none-AKI(NAKI)group and AKI Group.Clinical characteristics,laboratory test results,renal function recovery,maternal and infant outcomes were compared.Risk factors of incidence of AKI were analyzed.ResultsA total of 556 cases of ICU maternal clinical data were collected,148 subjects with preeclampsia were included in this study,61 cases(10.9%)were diagnosed with AKI.including 38 cases(6.8%)in AKI stage 1,14 cases(2.5%)in AKI stage 2 and 9 cases(1.6%)in AKI stage 3;there were no statistically significant differences in the complications of pregnancy between NAKI group and AKI group,including acute fatty liver of pregnancy(AFLP).HELLP syndrome,diabetes and postpartum hemorrhage.The incidence of pulmonary hypertension in AKI group was significantly higher than that in NAKI group(18.0%vs.4.6%.P＝0.008).Compared with NAKI group,the patients stayed in hospital longer in AKI group(9.1 ± 3.72 vs.7.60 ± 2.76,P=0.004).and the hospital stays of patients with AKI stage 2/3 were significantly higher than those with AKI stage 1 and NAKI(10.09 ± 4.36 vs.8.61 ± 3.20,7.60 ± 2.76,P=0.003).Patients in AKI group had significantly higher levels of cystatin,retinol binding protein.Beta2-microglobulin,creatinine,hospitalized maximum creatinine,K+level,acute physiology and chronic health evaluation II(APACHE II)than patients in NAKI group,and albumin level lower than patients in NAKI group(P<0.05),and the more severe the renal impairment,the higher the cystatin,Beta2-microglobulin creatinine,hospitalized maximum creatinine,K+level,and APACHE Ⅱ.About 82.0%of AKI patients recovered renal function upon discharge and the recovery rate of AKI stage 1 was significantly higher than that of AKl stage 2/3(92.1%vs.65.2%,P=0.008).There were no statistically significant differences in the pregnancy outcomes(survival,premature delivery and stillbirth)and urinary protein between NAKI group and AKI group(P>0.05).Pulmonary hypertension and low albumin were the independent risk factors for AKI(pulmonary hypertension:odds ratio(OR)=6,618,95%confidence interval(95%CI)was 1.625～26.948,P＝0.008;albumin:OR=0.91 1.95%CI was 0.839～0.989,P=0.026).ROC curve analysis showed that cystatin,Beta2-microglobulin,retinol binding protein,and creatinine all had good predictive values for P-AKI with preeclampsia patients in ICU,the cut-off value was 2.24mg/L.2.69mg/L.39.73mg/L and 90.17umol/L.respectively,and the AUC was 0.698.0.844,0.740 and 0.963,respectively(all P＜0.001).ConclusionsICU patients with preeclampsia have a higher incidence of AKI,which can lead to longer hospital stays.Most patients with preeclampsia who have AKI have renal function restored upon discharge.Pulmonary artery pressure and low albumin are independent risk factors for AKl in patients with preeclampsia in ICU.The basic creatinine value has the highest predictive value for preeclampsia complicated with AKI.