Risk Factors And Prognosis Of Acute Kidney Injury In Critical Patients With Acute Cerebrovascular Disease

Backgrounds and ObjectiveAcute kidney injury(AKI)is one of the most common complications in patients after an sever acute cerebrovascular disease(ACVD).Critically ill patients with ACVD always have an adverse outcome.The occurrence and stage of AKI are directly related to the prognosis of ACVD.With the new definition and staging of the AKI been worked out by Chronic Kidney Disease Epidemiology Collaboration(KDIGO)in 2012,there has been a new understanding of the clinical management of ACVD in critically ill patients with AKI.Patients with AKI which defined by KDIGO criteria in patients after an episode of ACVD were enrolled who admitted to the intensive care unit in this retrospective analysis study.Hence,we conducted this retrospective study aimed at identifying both risk factors for the occurrence of AKI in patients with ACVD and prognostic factors for short-term prognosis.Then,we can take some measures to prevent AKI earlier and improve the prognosis.Methods1.This was a retrospective study of the inpatients with acute cerebrovascular disease(ACVD)who were admitted to the ICU from 2016.01.01-2020.12.31.According to the inclusion and exclusion criteria,ultimately selected 499 cases of inpatients with ACVD.AKI(n = 308)was determined using 2012(KDOQI)guidance for changes in creatinine,and the control group was random selected from the patients admitted in the same period without AKI(n = 191).By means of logistic regression analysis,we investigated the risk factors of ACVD critical patients with AKI.2.ACVD critical patients complicated with AKI(n=308)were divided into acute kidney injury group(ACVD complicated with AKI stage 1 and stage 2,n=257)and acute renal failure group(ACVD complicated with AKI stage 3,n=51)according to the staging criteria of AKI in 2012(KDOQI)guidelines.Log-rank test and Kaplan-Meier curve were drawn to observe the short-term prognosis of ACVD patients complicated with AKI of different degrees.Multivariate Cox regression analysis was used to investigate the factors affecting the short-term prognosis of ACVD patients with AKI complication.Results1.A total of 499 patients meeting the criteria were included,including 308 in the AKI group and 191 in the non-AKI group.The incidence of AKI with ACVD patients was 61.7%.2.Compared to the non-AKI group,a significant number of AKI group patients exhibited a higher ratio of received mechanical ventilation and medications used including diuretic,mannitol,NSAIDs,colloid and vasoactive agents.Levels of serum potassium,sodium,chloridion,blood uric acid,fibrinogen,INR,D-dimer,C-reactive protein,procalcitonin,alanine aminotransferase,creatine kinase and creatine kinase isoenzyme were all higher(P < 0.05).3.Multivariate Logistic regression analysis showed that hypernatremia,hyperuricemia and use of diuretics were all independent risk factors for ACVD patients with AKI.ROC curve analysis indicated that hypernatremia(AUC was0.741)and hyperuricemia(AUC was 0.677)were important clinical indicators for predicting AKI in ACVD patients.The optimal serum sodium ion concentration was 146.65 mmol/L and the optimal serum uric acid concentration was 370.2 μmol/L,and the combination of the two(AUC was 0.774)was more significant in predicting AKI.4.Log-rank test showed that the 30 days mortality rate in the acute kidney injury group was lower than that in the acute renal failure group,and the difference was statistically significant(P < 0.001).5.Multivariate Cox survival analysis showed that AKI stage 3,hypernatremia and hypertension were independent risk factors for 30 days’ death in critical patients with ACVD complicated with AKI.Conclusion1.During the treatment process of ACVD patients in ICU,attention should be paid to the monitoring of serum sodium concentration and blood uric acid,timely intervention of hypernatremia and hyperuricemia and reasonable use of diuretics can prevent AKI in ACVD patients.2.ACVD critical patients have a higher incidence of AKI.Hypernatremia and hyperuricemia are both important clinical indicators to predict the occurrence of AKI,and the combined prediction of the two is of greater significance.3.Compared with patients with ACVD complicated with AKI stage 1 and 2,the 30 days mortality was significantly increased in patients with ACVD complicated with AKI stage 3.4.Hypernatremia,hypertension,and AKI stage 3 are associated with short-term poor outcomes in patients with ACVD complicated with AKI.