The Effect Of Duration Of Acute Renal Injury On Prognosis Of Sepsis

Acute renal injury(acute kidney injury,AKI)is one of the most common syndromes in severe patients.Its high mortality and poor prognosis make it a health problem all over the world.This trend is expected to continue.AKI has become an important factor affecting the prognosis of patients with sepsis.The main purpose of this study was to explore the risk factors of sepsis complicated with AKI and the influence of AKI duration on clinical progress and prognosis in order to provide evidence for clinical improvement of AKI identification and intervention management in patients with sepsis and shortening AKI duration.Objective: This paper aims to investigate the factors of acute renal injury(AKI)in hospitalized patients with sepsis and the effect of AKI duration on renal prognosis and clinical prognosis.Methods:1.From October 2013 to July 2018,127 patients with sepsis in emergency ICU of Anqing Hospital affiliated to Anhui Medical University were collected retrospectively.59 patients with sepsis complicated with AKI were selected as AKI group(male: female= 38:21).Age(63.05 ±16.05)years;Sixty-eight patients with sepsis without AKI at the same time were taken as control group(male: female = 36:32),aged(59.56 ±17.18)years.59 cases of AKI were further divided into two groups: AKI 12(29 cases)and AKI stage 3(30 cases),including 19 males and 10 females with age(67.14 ±13.95)years old in AKI phase 12 group,and 19 males and 11 females with age(59.10 ±17.15)years in AKI stage 3 group.2.The results of blood culture,albumin,total bilirubin,carbon dioxide binding force,white blood cell count,platelet count,serum potassium,C-reactive protein,procalcitonin,serum creatinine were collected.3.Define the recovery of renal function in acute renal injury and determine the duration of AKI according to the relevant inclusion criteria.4.The patients with AKI were followed up until 3 months after death or discharge.The survival status between AKI duration > 2 days group and AKI duration ? 2 days group,AKI group 12 stage group and AKI stage 3 group was compared.Results:1.The general data of non AKI group and AKI group were compared.The duration of total hospitalization in AKI group was higher than that in non AKI group,including the occurrence of blood pressure booster,septic shock,mechanical ventilation,application of CRRT and the duration of ICU hospitalization.The difference was statistically significant(P < 0.05).2.Compared with AKI group,the white blood cell count,procalcitonin,C-reactive protein,creatinine,uric acid and total bilirubin in AKI group were significantly higher than those in non-AKI group.However,the platelet count,carbon dioxide bindingcapacity and mean arterial pressure in AKI group were significantly lower than those in non-AKI group(P < 0.05).Serum potassium level,positive rate of blood culture,albumin level and hemoglobin level were not risk factors(P > 0.05).3.Compared with the general data of AKI group,the use of CRRT,the hospitalization time of serum creatinine,ICU,the duration of AKI and the proportion of duration > 2days in AKI 12 group were lower than those in AKI stage 3 group.The survival rate within 90 days after onset of AKI was lower than that in AKI stage 3 group.But the rate of complete recovery of renal function in AKI 12 stage group was significantly higher than that in AKI 3 stage group,and that in AKI 3 stage group was significantly higher than that in AKI 12 stage group(P < 0 05).There was no significant difference between the two groups in blood pressure booster,septic shock,mechanical ventilation,sex,age,total hospitalization days and partial recovery of renal function(P > 0.05).4.Survival analysis showed that there was significant difference between AKI duration > 2 days group and AKI duration ? 2 day group(log-rank test,x2=6.487,x2= 6.487).There was statistical significance in Kaplan-Meier survival analysis between stage 12 group and AKI stage 3 group in).AKI group(log-rank test,x2=7.304P=0.007).Conclusion:Factors for sepsis complicated with AKI consist in the increase of PCT,CRP as well as the decrease PLT and MAP.Furthermore,the duration of AKI > 2 days was associated with adverse clinical progress and prognosis.