Analysis Of The Current Situation And Risk Factors Of Acute Kidney Injury In Critically Ill Patients In Emergency Department

Background:Acute kidney injury(AKI)is one of the common complications of critical patients in the Emergency Department,which affects the prognosis of patients.Once AKI occured,improper treatment may lead to chronic kidney disease(CKD)and end-stage renal disease(ESRD),which can also indicate extended hospital stay,and increased social and family burdens.The reported incidence of AKI varies due to the differences in races,region,and diagnostic criteria.The incidence of AKI in critically patients is about 30-50%.AKI is also an independent risk factor for death,and the risk of death increases with the clinical stages in the progression of AKI.AKI progressed to stage 3,the mortality rate exceeds 50%.At present,there are no specific treatments for AKI,only supportive therapies available,such as correcting water-electrolyte and acid-base imbalances,reducing volume load,and removing toxins by CRRT.Therefore,early recognition of acute kidney injury and early intervention is significant for the prognosis of patients.This study is a retrospective study,The electronic medical records in our system were used to collect the clinical data of patients with AKI in the resuscitation room.We analyzed the incidence of AKI,discussed the risk factors and potential interference factors,implement early interventions on AKI,and avoid the occurrence of AKI.Purpose:1)To investigate the incidence of AKI in critically patients in the resuscitation room;2)To determine the risk factors leading to AKI;3)To study the relationship between the occurence and prognosis of acute kindey injury in critically patients.Methods:All critically ill patients admitted to the Emergency Intensive Care from September 2018 to December 2018 were collected,and 238 cases with complete data were finally selected.All patients' clinical information was collected,including basic information,primary diseases,auxiliary examinations,treatment plans,etc.The 2012 KDIGO Guidelines defined the definition criteria for AKI.According to the occurrence of AKI within seven days of admission,the patients were divided into AKI group and non-AKI group.Then the risk factors and prognosis of AKI were furtherly explored.Statistical methods:Statistical software STATA16.0IC was used.Classified variables were represented by constituent ratio,and continuous variables were described by mean ± standard deviation or the interval between median and quaternary.Statistical methods included t-test,X2 test,univariate analysis,multivariate Logistic analysis,and Cox regression analysis.Results:1.The occurrence and basic characteristics of AKIThe study eventually included 238 critically ill patients,with an average age of 58± 18 years(17-97 years).Among them,there were 54 cases of hypertension(22.7%),50 cases of diabetes(21.0%),17 cases(7.1%)of patients with primary chronic kidney disease,and 134 cases of patients with urethra(56.5%),the median Acute Physiological and Chronic Health Evaluation score(APACHE II)for hospitalization was 13(9,18)and the median fluid volume(ml)for 24 hours after hospitalization was 2700(1600,3700).There were 108 cases(45.4%)of acute kidney injuries,of which 83(34.9%)were at AKI stage I and 25 cases(10.5%)were at AKI stage 2-3.2.Risk factors and prognosm analysisThe population study analysis of patients in the resuscitation room showed the application of vasopressors and APACHE II score were associated with the occurrence of AKI;patients with AKI have a higher rate of urinary catheter placement.Multi-factor Logistic analysis showed that higher APACHE ? score(OR=1.11,P<0.01),application of vasopressors(OR=2.20,P=0.03),underlying diabetes(OR=2.33,P=0.01)were independent risk factors for AKI occurrence.In addition,further multi-factor Logistic analysis indicated that APACHE II>13,lactic acid>4mmol/L were common risk factors for AKI stage 1 and 2-3.The application of vasopressors(OR=2.41,P=0.02),diabetes(OR=2.38,P=0.01)were an independent risk factor for AKI stage 1,while intravenous fluid volume in 24 hours>3L(OR=3.10,P=0.02),and digestive tract bleeding(OR=1.79,P=0.04)were an independent risk factor for AKI stage 2-3.COX regression analysis found that the occurrence of AKI was related to the 30-day survival rate,which decreased with the progression of the phase.After correcting age and APACHE II scores,AKI was an independent risk factor for death in ill patients.The severity of the AKI significantly increased the risk of death in patients with AKI stage 1 HR=1.45,95%CI(1.08-2.03),p=0.04;AKI stage 2-3 HR=3.15,95%CI(1.49-4.81),p=0.03.Conclusion:1.The occurrence rate of AKI is higher among critically patients in the resuscitation room;2.Diabetes,application of vasopressors,and high APACHE ? score are independent risk factors for AKI;3.Intravenous fluid volume in 24 hours is also an independent risk factor for AKI,and compared with patients without AKI,patients with AKI have a higher incidence of urinary catheter placement;4.The risk of death increases in patients with AKI,and furtherly increases with progressed stages.Thus early identification of AKI,improvement of associated risk factors may prevent AKI and improve short-and long-term prognosis.