Analysis Of Related Factors Of Acute Kideny Injury In Patients Of Critical Medicine Department

Objective: To explore the risk factors and prognosis of Acute Kidney Injury(AKI)in intensivlly ill patients in Guilin Medical College by analyzing the data of patients in ICU,Affiliated Hospital of Guilin Medical College.Methods: From January 1,2018 to December 31,2018,185 patients with severe diseases in our hospital were collected through the medical records system.After excluding those who did not meet the requirements,a total of 83 patients were selected as the study subjects.Based on the diagnostic criteria of AKI proposed by Kidney Disease: Improving Global Outcomes(KDIGO)in 2012,the patients were divided into AKI group and non-AKI group.The clinical data and laboratory examination data of AKI group and non-AKI group were statistically analyzed to find out the risk factors of AKI.To clarify the difference between sepsis and non-sepsis patients in AKI patients,they were divided into sepsis group and non-sepsis group.The clinical data and laboratory examination data of the two groups were analyzed.The counting data were described by n(%)cases,and the statistical inference of the differences between groups was tested by two tests;the measurement data were described by mean(±)standard deviation(x(±)and the normality test was described by Shapiro-Wilk normality test,and the comparison between groups with normal distribution was analyzed by t test,while the comparison between groups without normal distribution was analyzed by non-parametric rank sum test.Multivariate correlation analysis using binary logistic regression model analysis,according to P < 0.05,the difference was statistically significant.Results: There were significant differences in age,creatinine value,APACHE II score and sepsis between AKI group and non-AKI group(P < 0.05),but there were no significant differences in gender,history of diabetes mellitus and history of CKD between the two groups(P > 0.05).Logistic regression analysis showed that serum creatinine and APACHE II score were independent risk factors for AKI(OR > 1).The ROC curve of predicting AKI in severe patients with APACHE II score indicates that AUC 0.783(95% CI 0.683-0.884)has a sensitivity of 68.3% and specificity of 81% when APACHE II score is more than 24 minutes.The stage of AKI was positively correlated with mortality,and there was significant difference in mortality among different stages(P < 0.05).Renal replacement therapy in stage AKI 3 did not reduce mortality.In AKI group,the ROC curve predicting AKI patients’ death with APACHE II score suggests that it has predictive value in non-sepsis group.AUC 0.741(95% CI 0.583-0.899),when APACHE II score 25 was selected,the mortality rate increased significantly.Conclusions:(1)Age,serum creatinine and APACHE II score sepsis are risk factors for AKI in ICU patients.The older the age,the higher the serum creatinine,the higher the APACHE II score,and the higher the incidence of AKI in sepsis patients.(2)Serum creatinine and APACHE II score were independent risk factors for AKI.ICU patients with AKI had longer hospitalization time and higher mortality.APACHE II score predicted AKI ROC curve AUC 0.783 in severe patients.When APACHE II score was more than 24 minutes,the sensitivity and specificity of AKI diagnosis were 68.3% and 81%.(3)Compared with patients admitted to ICU for other reasons,patients admitted to ICU for sepsis had a milder condition,but with the development of the disease,there was still a higher possibility of AKI,which should be paid close attention to.(4)AKI staging was associated with mortality.In patients with AKI,early renal replacement therapy may reduce the mortality rate of sepsis patients with AKI,while AKI 3 renal replacement therapy does not reduce the mortality rate.In AKI non-sepsis group,the mortality rate increased significantly when APACHE II score was more than 25.