Analysis Of The Risk Factors And Prognosis In Patients With Sepsis-associate Acute Renal Injury

Objective: To explore the incidence and prognostic factors of patients with sepsis-associate acute kidney injury(SA-AKI),so as to provide basis for the formulation of effective treatment strategies in clinical practice and improve the prognosis.Methods: Patients with sepsis who were admitted to the department of critical care medicine of the First Affiliated Hospital of Chongqing Medical University from 2017-09-01 to 2019-08-31 were collected.According to the diagnostic criteria of acute kidney injury,patients with sepsis were divided into two groups: patients with AKI the Sepsis-associate acute kidney injury(SA-AKI)group and the patients without AKI group.The clinical indexes of the two groups were compared,and the risk factors of sepsis with AKI were analyzed by multivariate Logistic regression.The patient with AKI were divided into death group and survival group according to whether they died during hospitalization,to analyzed the effects of various clinical indicators and CRRT on the prognosis of SA-AKI patients.We took an one-year followed-up after the SA-AKI patients improved and discharged,and analyzed the risk factors of the Patients with SA-AKI progressed to chronic kidney disease(CKD)by multivariate Logistic regression.Results: A total of 82 patients with sepsis who met the inclusion and exclusion criteria were collected,including 63 patients with AKI and 19 patients without AKI.The incidence of SA-AKI was 76.83%.28 patients died in hospital,with a mortality rate of 34.15%.As compared with sepsis without AKI group,higher ratio of hypertension,MODS,vasoactive drugs and diuretic use,and mechanical ventilation,higher APACHE Ⅱ score,SOFA score,hospitalization cost and hospital mortality,longer mechanical ventilation duration were found in SA-AKI group(P<0.05).There was no significant difference in infection site,etiology and use of anti-infective drugs between the two groups(P>0.05).The multivariate logistic regression analysis showed the high APACHE Ⅱ score,using of mechanical ventilation and low platelet count were risk factors for AKI incidence in sepsis patients.In SA-AKI patients,26 patients died in hospital,with a mortality rate of 41.3%.There were higher APACHE Ⅱ score and SOFA score,higher morbidity of MODS and higher proportion of mechanical ventilation in death group in comparison to survival group(P<0.05),and there was no significant difference in CRRT between these two groups(P>0.05).1 year follow-up shows 3 patients died within one year after discharge,accounting for 10.7%;and 4 patients progressed to CKD,accounting for 14.3%,and diabetes was the risk factor for progression to CKD(95%CI: 0.005-0.816).Conclusion: The in-hospital mortality and hospitalization cost in SA-AKI patients were significantly higher than those in sepsis patients without AKI,and there was no significant difference in infection site,etiology and use of anti-infective drugs between the two groups.The risk factors for AKI incidence in sepsis patients were high APACHE Ⅱ score,usage of mechanical ventilation and low platelet count.There were higher APACHE Ⅱ score and SOFA score,higher morbidity of MODS and higher proportion of mechanical ventilation in SA-AKI death group in comparison to survival group(p<0.05).Diabetes is a risk factor for SA-AKI patients progressing to CKD within one year.