Research About Prognosis In Patients With Hospital-acquired Acute Kidney Injury

PART1Clinical Characteristics and Prognostic Factors in Patients with Hospital-acquired Acute Kidney InjuryObjectivesTo examine clinical characteristics and prognostic factors in patients with hospital-acquired acute kidney injury and to investigate the risk factors for90days all-cause mortality.Patients and Methods357patients with hospital-acquired AKI were recruited to this prospective cohort study according to RIFLE criteria. Clinical data and laboratory test results were collected and the etiology and distribution characteristics of patients with AKI were analyzed. Cox regression analysis was used to investigate the prognostic risk factors of AKI.Results159patients died within90days, and the mortality reached44.5%. Univariate analysis showed that death group and survival group were significantly different in mechanical ventilation, sepsis, and several laboratory indicators (p<0.05). Cox regression model suggested that PLT、TB、prealbumin、GCS、MAP and BUN were independent prognostic risk factors for patients with AKI (p<0.05), and the area under the ROC curve was0.847, indicating potential predictive value for90days mortality.ConclusionsAKI is one of the most common clinical syndromes in hospitalized patients.PLT、 TB、prealbumin、GCS、MAP、BUN are independent prognostic risk factors of patients with hospital-acquired AKI. PART2The Ratio of CRP to Prealbumin Levels Predict Mortality in Patients with Hospital-acquired Acute Kidney InjuryObjectivesTo examine whether the combination of inflammatory and nutritional markers could predict the mortality of AKI patients.Patients and Methods155patients with hospital-acquired AKI were recruited to this prospective cohort study according to RIFLE criteria. C-reactive protein (CRP), and the nutritional markers (albumin, prealbumin and cholesterol) measured at nephrology consultation were analyzed in relation to all cause mortality of these patients. In addition, CRP and prealbumin were also measured in healthy controls, maintenance hemodialysis and peritoneal dialysis patients and then compared with AKI patients.ResultsCompared with healthy controls and end-stage renal disease patients on maintenance hemodialysis or peritoneal dialysis, patients with AKI had significantly higher levels of CRP/prealbumin (p<0.001). Higher level of serum CRP and lower levels of albumin, prealbumin and cholesterol were found to be significant in the patients with AKI who died than those who survived. Similarly, the combined factors including the ratio of CRP to albumin (CRP/albumin)、CRP/prealbumin and CRP/cholesterol were also significantly higher in the former group (p<0.001for all). Multivariate analysis (Cox regression) revealed that CRP/prealbumin was independently associated with mortality after adjustment for age, gender, sepsis and SOFA (p=0.027) while the others (CRP, albumin, prealbumin, cholesterol, CRP/albumin and CRP/cholesterol) became non-significantly associated. The hazard ratio was1.00(reference),1.85,2.25and3.89for CRP/prealbumin increasing according to quartiles (p=0.01).ConclusionsInflammation and malnutrition were common in patients with AKI. Higher level of the ratio of CRP to prealbumin was associated with mortality of AKI patients independent of the severity of illness and it may be a valuable addition to SOFA score to predict the prognosis of AKI patients. PART3Nitrotyrosine and Thiol Levels were Associated with Mortality in Patients with Acute Kidney InjuryObjectivesTo examine the characteristics of oxidative stress in patients with acute kidney injury (AKI) and investigate the association between plasma protein oxidation levels and90-day mortality in patients with AKI.Patients and Methods158patients with hospital-acquired AKI were recruited to this prospective cohort study according to RIFLE (Risk, Injury, Failure, Lost or End Stage Kidney) criteria. Twelve critically ill patients without AKI and15age and gender-matched healthy subjects were enrolled as control. Plasma protein oxidation biomarkers (3-nitrotyrosine and thiol) were analyzed in relation to all cause mortality of patients with AKI.ResultsHighest3-NT/Tyr was detected in patients with AKI compared with healthy subjects, and critically ill patients without AKI (ANOVA p<0.001). The concentration of thiol group in AKI patients was lower than that of healthy people but higher than that of critically ill patient (ANOVA, p=0.002). The3-NT/Tyr level was significantly associated with the severity of AKI (ANOVA, p<0.001). The90-day overall mortality was significantly higher in the group with high3-NT/Tyr (p=0.001by log-rank test) or high thiol concentration (p=0.032by log-rank test). Multivariate analysis (Cox regression) revealed that3-NT/Tyr (p=0.025) and thiol (p=0.008) were independently associated with mortality after adjustment for age、gender、sepsis and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score.ConclusionsThere is excess plasma protein oxidation in patients with AKI, as evidenced by increased nitrotyrosine content and diminished thiol content.3-NT and thiol were associated with mortality of AKI patients independent of the severity of illness.