Retrospective Analysis Of The Risk Factors And Prognosis Of Sepsis-Associated Acute Kidney Injury In ICU

Objectives:To investigate the incidence,mortality,risk factors and prognosis of sepsis associated acute kidney injury(AKI)in emergency intensive care unit(EICU),in order to help clinicians understand the epidemiology of sepsis associated acute kidney injury,early warning of sepsis associated acute kidney injury,and guide early intervention to reduce mortality.Methods:The retrospective and single-central study was done at Emergency Intensive Care Unit of first affiliated hospital of Kunming Medical University.146 subjects were included,they were divided into two groups:SA-AKI group(Sepsis Associated Acute Kidney Injury)and Non AKI group according to the diagnostic criteria of AKI.The clinical data of both the two groups were compared,and multivariate logistic regression method was used to explore the possible risk and prognostic factors of sepsis associated acute kidney injury.Results:146 patients with sepsis were analyzed in this study,in which 84 subjects were sepsis associated acute kidney injury(SA-AKI group),while 62 patients were in Non-AKI group.The mortality of 28 days and 90 days in SA-AKI group were 71.63%and 72.62%,the mortality in Non-AKI were respectively 50.00%and 58.06%.The SA-AKI group has a higher mortality than Non-AKI group at 28 days(P<0.05),but the mortality at 90 days in both group has no statistical significance(P>0.05).According to the worst laboratory results in 24 hours aftter AKI,84 patients with SA-AKI were divided into 3 stages:25 cases in stage 1,24 cases in stage 2,and 35 patients in stage 3.18 patients of SA-AKI received continuous renal replacement therapy(CRRT),the CRRT started at stage 1 in 2 cases,at stage 2 in 2 subjects and at stage 3 in 14 subjects.The mortality of each stage in SA-AKI group increased with the increase of AKI stage,and there was no significant difference between the 28 day mortality of CRRT group and Non-CRRT group(P>0.05).There were significant differences between SA-AKI group and Non-AKI group in ICU hospitalization time,chronic healthy status of patients,fungal infection,the levels of creatinine(Cre),blood urea nitrogen(BUN),cysteine statin-C(cys-C)and anti-thrombin Ⅲ(AT-Ⅲ),acute physiology and chronic healthy ecaluation Ⅱ(APACHEⅡ),Galsgow coma score(GCS)and sepsis related organ failure assessment score(SOFA score)(P<0.05).According to multivariate logistic regression analysis,the first few risk factors for sepsis-induced AKI were:combined chronic diseases,fungal infections,AT-Ⅲ values,SOFA scores,and disturbance of consciousness(P<0.05).In different stage of SA-AKI,there was a significant difference in both APACHE Ⅱ score,SOFA score and the level of Cre,BUN and(Cys-C)(P<0.05).Conclusions:1.The incidence of complications of sepsis complicated by AKI and 28-day mortality were significantly higher than those of non-AKI sepsis groups.CRRT treatment in sepsis AKI group did not reduce 28-day mortality.The analysis may be related to the late start of CRRT treatment.2.the first few risk factors for sepsis-induced AKI were:combined chronic diseases,fungal infections,AT-Ⅲ values,SOFA scores,and disturbance of consciousness.