Clinical Study On The Short-term Renal Function Outcome Of Patients With Sepsis-associated Acute Kidney Injury

Part one Clinical characteristics and prognosis analysis of patients with acute kidney injury in the emergency roomObjectiveTo analyze the clinical characteristics and prognostic risk factors of patients with acute kidney injury(AKI)in the emergency room.MethodsRetrospective collection of all patients with acute kidney injury from June,2019 to July,2020 in the emergency room of General Hospital of the Eastern Theater Command,PLA.Epidemiology relevant clinical data and laboratory indices of the above patients were collected for descriptive statistical analysis,and patients were divided into survival and death groups according to their 28-day survival status.Univariate analysis and multivariate Logistic regression analysis were performed to determine AKI patients independent risk factors for 28d death.ResaultsA total of 347 patients with acute kidney injury were included in the study,with an average age of 49.59±19.54 years.There were 221 males,126 females,with amale to female ratio 1.75:1.There were 82 cases(23.6%),52 cases(15.0%),and 213 cases(61.4%)in AKI stages Ⅰ、Ⅱ、and Ⅲ respectively.124 patients(35.7%)were associated to sepsis.Multivariate logistic regression analysis showed that age(OR=1.077,95%CI:1.041-1.113,P<0.001),coronary heart disease(OR=6.199,95%CI:1.902-20.205,P=0.002),use of vasoactive drugs(OR=5.039,95%CI:1.294-19.629,P=0.020),D-Dimer(OR=1.075,95%CI:1.019-1.133,P=0.008)and SOFA scores(OR=1.474,95%CI:1.228-1.769,P<0.001),were independent risk factors that affected the 28-day poor prognosis of AKI patients(P<0.05).The above-mentioned indexes combined model predicts that the area under the ROC of 28d death of AKI patients is 0.939(95%CI:0.908-0.962,P<0.05).ConclusionSepsis is a common cause of AKI patients.Old age,coronary heart disease,use of vasoactive drugs,high D-Dimer and high SOFA scores are independent risk factors for 28-day death in AKI patients.The combination of the above indicators to establish a model has a higher predictive value of 28-day death in AKI patients.Part two The predictive value of dynamic changes of early clinical indicators for patients with sepsis-associated acute kidney injury in short term renal function outcomeObjectiveTo understand the outcome of renal function and related influencing factors in patients with sepsis-associated acute kidney injury(SAKI),and to explore the predictive value of early dynamic changes of clinical indicators on the short-term renal function outcomes of SAKI patients.MethodsThe SAKI patients who were treated in the emergency room of General Hospital of the Eastern Theater Command,PLA from August 2019 to August 2020 were selected.According to the survival status and renal function outcomes of SAKI patients at 28-days after admission,they were classified as complete renal function recovery group,partial renal function recovery group and non-recovery renal function group.Logistic regression was used to analyze the influencing factors of renal function outcome,and the area under the ROC curve was used to analyze the predictive value of blood PCT and PLT on poor renal function outcome.ResultsA total of 114 patients were enrolled in the study.There were 55 patients in the complete renal function recovery group,29 patients in the partial renal function recovery group,and 30 patients in the non-recovery renal function group.The unrecovered rate of renal function in SAKI patients reached 26.3%.The most common source of infection was respiratory infection and abdominal cavity infection.Logistic regression analysis showed that the factors affecting the outcome of renal function in SAKI patients were age,AKI stage and SOFA scores.There were no statistically significant differences in PCT and PLT levels between the three groups at admission(P>0.05),but the differences in PCT and PLT levels were statistically significant after the third day(P<0.05).ConclusionOld age,high AKI staging,and high SOFA score are independent risk factors for poor renal function prognosis in SAKI patients.The combination of the above indicators to establish a model has a higher predictive value for poor renal function prognosis in SAKI patients at 28 days.Early changes in blood PCT and PLT levels are related to the outcome of renal function in SAKI patients.