Study On The Clinical Characteristics, Prognosis And Distribution Of TCM Syndrome Elements In Patients With Acute Kidney Injury In CCU

Objective:To study the clinical characteristics,prognosis and the distributions of TCM syndromes of acute kidney injury(AKI)in the Coronary Care Unit(CCU)of Dongzhimen Hospital of Beijing University of traditional Chinese medicineMethods:According to the diagnostic standard of AKI in the Kidney Disease Improving Global Outcomes,AKI patients who were in the CCU of Dongzhimen Hospital of Beijing University of traditional Chinese medicine from January 2014 to December 2018 were enrolled.The demographic data,basic diseases,laboratory results,treatment drugs,clinical outcomes,TCM syndromes were collected to study the clinical characteristics,prognosis and TCM syndromes of AKI patients.Results:(1)332 patients with AKI were enrolled,with the average age of 76.22±10.08 years old,and the ratio of male to female was 1.27:1.Prerenal factors,renal factors,postrenal factors and unexplained causes accounted for 80.42%,12.65%,1.81%and 5.12%respectively.The ratio of stage 1,2 and 3 of AKI was 78.31%,18.98%and 2.71%respectively.The serum creatinine(Scr)at the diagnosis of AKI was 160.25(119.08,224.83)umol/L,and at the time of discharge was 141.55(105.00,141.55)umol/L.The proportion of patients with acute coronary syndrome and heart failure was 52.71%and 38.86%respectively.(2)The elderly group(?60 years old)and the non-elderly group(<60 years old)are divided according to age.The results showed that 308 cases(92.78%)in the elderly group and 24 cases(7.23%)in the non-elderly group.In terms of basic diseases and accompanying symptoms,the proportion of hypertension,chronic kidney disease,cerebrovascular disease,hypoproteinemia,anemia,oliguria,anuria and infection in the elderly group was higher than that in the non-elderly group(P<0.05).In terms of laboratory results,the values of hemoglobin(Hb),albumin(ALB)and estimated glomerular filtration rate(eGFR)in the elderly group were lower than those in the non-elderly group,the values of urea nitrogen(BUN),Scr at the diagnosis and at the discharge,the peak value of Scr and NT-probrain natriuretic peptide(NT-proBNP)was higher than that in the non-elderly group(P<0.05).The use of antibiotics and diuretics in the elderly group was higher than that in the non-elderly group(P<0.05).(3)According to whether the patients had chronic kidney disease when they entered CCU,they were divided into 100 cases(30.12%)with chronic kidney disease and 232 cases(69.88%)without chronic kidney disease.The age of chronic kidney disease group was higher than that of non-chronic kidney disease group.In terms of basic diseases and accompanying symptoms,the proportion of chronic kidney disease group with hypertension,diabetes,hyperlipidemia,hyperuricemia,albuminuria,oliguria,hypoalbuminemia,anemia and infection was higher than that non-chronic kidney disease group.In the laboratory test,the Hb and eGFR of the group with chronic kidney disease group was lower than that of the group non-chronic kidney disease,and the values of K+,BUN,Scr at the diagnosis,the peak value of Scr,uric acid(UA)and NT-proBNP of the group with chronic kidney disease were higher than that of the group non-chronic kidney disease(P<0.05).In the treatment,the use of antibiotics,Shenkang Injection and renal replacement therapy of the group with chronic kidney disease was higher than that of the group non-chronic kidney disease(P<0.05)(4)According to the recovery of renal function at discharge,175 cases(52.71%)and 157 cases(47.29%)were divided into renal function recovery group and non-recovery group respectively.In terms of clinical symptoms,the proportion of anemia,hypoalbuminemia,and multiple organ dysfunction syndrome(MODS)in renal function recovery group was lower than that in renal function non-recovery group.Laboratory results showed that Hb,ALB and Ca2+in renal function recovery group was higher than that in renal function non-recovery group,wheres lactate dehydrogenase(LDH)was lower.In terms of treatment,the proportion of diuretics,vasoactive drugs and mechanical ventilation in the renal function recovery group was lower than that in the renal function non-recovery group,and the proportion of Shenkang injection was higher.In terms of clinical outcomes,the survival in the group with renal function recovery was higher than that in the group without renal function recovery Multivariate logistic analysis showed that Shenkang Injection(OR=0.580)were protective factors for the prognosis of renal function in AKI patients.Hypocalcemia(OR=1.631),anemia(OR=1.667),hypoproteinemia(OR=1.621),MODS(OR=4.388),diuretic use(OR=1.111)were independent risk factors for the prognosis of renal function in AKI patients(5)According to the outcome of discharge,the patients were divided into survival group(250 cases)(75.30%),death group(82 cases)(24.70%).In the survival group,there were 205 cases(82.00%)in the first stage,41 cases(16.40%)in the second stage,and 4 cases(1.60%)in the third stage.In the death group,there were 55 cases(67.07%)in the first stage,22 cases(26.83%)in the second stage,and 5 cases(6.01%)in the third stage.The staging comparison showed that with the increase of the grading degree,the mortality gradually increased.And the difference between the groups was statistically significant(P<0.05).The age of death group was higher than that of survival group.In terms of clinical symptoms,the proportion of death group with hypoproteinemia,anemia,albuminuria,oliguria.anuria,infection and MODS was higher than that of survival group.Laboratory results showed that the baseline value of Scr,Scr at the diagnosis of AKI,the peak value of Scr,Scr at discharge,the peak value of UA,BUN,NT-proBNP in the death group were higher than those in the survival group,and ALB,Hb,Ca2+,eGFR were lower than those in the survival group.In terms of treatment,the proportion of antibiotics,vasoactive drugs and mechanical ventilation used in the death group was higher than that in the survival group.The proportion of diuretic maximum dosage ?80mg/d in the death group was lower than that in the survival group,and the proportion of diuretic maximum dosage>160mg/d in the death group was higher than that in the survival group.Multivariate logistic analysis showed that Scr at discharge(OR=1.051),anemia(OR=3.014),hypoproteinemia(OR=4.203),MODS(OR=18.118),use of vasoactive drugs(OR=13.221)and mechanical ventilation(OR=1.718)were independent risk factors for the death of AKI patients.(6)In the distribution of TCM syndromes,pure deficiency syndrome,pure excess syndrome and deficiency and excess syndrome accounted for 8.73%,9.04%and 82.23%respectively.AKI patients were mostly mixed with deficiency and excess.Among the deficiency syndrome,192 cases(57.83%)were Qi deficiency,69 cases(20.78%)were blood deficiency,136 cases(40.96%)were Yin deficiency and 132 cases(39.76%)were Yang deficiency.The frequency of Qi deficiency is the highest,followed by Yin deficiency and Yang deficiency.Among the excess syndrome,130 cases(39.16%)were water retention syndrome,186 cases(56.02%)were blood stagnation syndrome,56 cases(16.87%)were fire heat syndrome and 175 cases(52.71%)were phlegm syndrome.The frequency of blood stagnation syndrome is the highest,followed by phlegm syndrome and water retention syndrome.The distribution of TCM syndrome elements in the survival group and the death group showed that the proportion of yang deficiency in the death group was higher than that in the survival group(P<0.05).Conclusion:(1)Prerenal factors and stage 1 of AKI is the most common in the AKI patients of CCU.(2)The elderly patients and Chronic Kidney Disease patients with multiple basic diseases and clinical symptoms are the high risk group of AKI.(3)The stage of AKI affects the prognosis of patients.With the increase of the degree,the mortality gradually increases.(4)Shenkang Injection are protective factors for the prognosis of renal function in AKI patients.Hypocalcemia,anemia,hypoproteinemia,MODS and diuretic use are independent risk factors for the prognosis of renal function in AKI patients.(5)Scr at discharge,anemia,hypoproteinemia,MODS,use of vasoactive drugs and mechanical ventilation are independent risk factors for the death of AKI patients.(6)AKI patients are mainly characterized by deficiency and excess.Qi deficiency is the most common deficiency syndromes,followed by yin deficiency and yang deficiency.Blood stagnation is the most common excess syndromes,followed by phlegm syndrome and water stagnation.(7)The prognosis of AKI patients with Yang deficiency syndrome is relatively poor.In summary,in order to improve the prognosis of patients,the risk factors,such as hypoproteinemia and anemia,should be corrected.Diuretics,vasoactive drugs and respirators,should be used properly.Meanwhile,the treatment of TCM should be based on tonifying Qi and nourishing yin,promoting blood circulation and removing blood stasis,as well as draining water and resolving phlegm.Also,the advantages of TCM in the prognosis of AKI patients should be paid attention.