Risk Factors And Prognosis Analysis Of Sepsis-induced Acute Renal Injury

Objective:To investigate the clinical feature,risk factors and prognostic factors of sepsis-induced acute kidney injury patients enrolled in the emergency intensive care unit(EICU)of Renji Hospital,which may help to early identify,prevent,postpone and even improve prognosis of septic acute kidney injury.Methods:This single-center retrospective study enrolled 319 sepsis patients from January 1,2014 to December 31,2018 at the emergency ICU of Renji hospital through the electronic health record system.101 patients were excluded according to the exclusive criteria,and 268 patients were included.The characteristics of participants were recorded in detail and analyzed by SPSS 25.0 statistical software.The main statistical methods included t-test,chi-square test,univariate correlation analysis and binary multivariate logistic analysis.Results:1.Our final cohort included 268 sepsis patients;172 patients were males(64.18%),96 patient were females(35.82%).The mean age was 69.12 ± 15.462 years old.60 patients died with a 28 days all-cause mortality rate 22.76%.And the mortality rate increased to 25.89%(51/197)in septic AKI group.While 9 patients(12.68%)died in the septic non-AKI group(P<0.05).Compared with the non-AKI group(including 1patient),AKI group(including 27 patients)had a higher rate of ventilation(13.71%VS.1.41%,P<0.05).The hospitalization expenses of patients in the septic AKI group were 48346 yuan(28207.5,77433.5),and the expenses of the non-AKI group were 30691 yuan(21893,47184)(P<0.05).Compared with the non-AKI group,AKI group had a longer length of stay(14(9,21)VS 10(7,14),P<0.05)2.Compared with the non-AKI group,the AKI group has lower value of PH,lactic acid,bicarbonate,base excess,albumin and mean arterial pressure,and has higher value of potassium ions,type B natriuretic peptide,white blood cell count,c-reactive protein,procalcitonin,glutamine transaminase,urea nitrogen and uric acid(P<0.05).Multivariate Logistic regression showed that mechanical ventilation,urea nitrogen and mean arterial pressure were independent risk factors for acute kidney injury induced by sepsis.3.In septic AKI group,a comparison between death and survivor group,shows that mechanical ventilation,lactic acid,urea nitrogen,length of stay and residual alkali were higher in the death group,while PH,albumin,bicarbonate and mean arterial pressure were lower in the death group,with statistical differences(P<0.05).The multivariate Logistic regression showes that lactic acid,albumin,urea nitrogen,and lung infection are independent risk factors for death in patients with septic AKI.4.In the group of septic AKI,there are 120 with lactic acid≦2mmol/L,and 60 with another acidosis(PH<7.35,HCO3-<21mmol/L or BE<-3)whose mortality numbers are 18 people(30.0%).Conclusion:In ICU patients,sepsis-induced AKI has a relatively high morbidity and mortality;Mechanical ventilation,urea nitrogen and mean arterial pressure are independent risk factors for sepsis-induced acute kidney injury.Lactic acid,albumin,urea nitrogen and pulmonary infection are independent risk factors for death in patients with septic AKI.A normal lactate level alone should not be used to exclude life-threatening sepsis.Patients with metabolic acidosis characterised by low bicarbonate,low PH or high BE levels,but with normal lactate levels,have high rates of mortality and should also be considered for early,aggressive therapy.