Analysis Of Risk Factors And Prognosis Of Acute Kidney Injury In Patients With ICU

Objective:To collect the clinical data of patients with acute kidney injury(AKI)in intensive care unit(ICU)and retrospectively analyze their etiology,clinical features,prognosis and influencing factors to help early detection,early prevention and improvement of prognosis in patients with AKI.Methods:From January 2014 to September 2018,226 patients with AKI in the First Affiliated Hospital of Kunming Medical University were included in the study.The incidence,mortality and etiology of AKI in ICU were analyzed,and logistic regression analysis was used to judge various factors.For the prognostic impact,the ROC curve was used to compare the predictive value of KDIGO criteria for AKI staging and APACHE Ⅱ scores for patient outcome.Results:During the study period,there were a total of 1542 inpatients in the ICU.A total of 1006 patients were excluded according to the exclusion criteria,including 226 cases of AKI and 121 deaths.The incidence of AKI was 22.5%,the mortality rate was 12.0%,and the mortality rate was 53.5%.The average age of onset was 58.2 years old,with a male to female ratio of 2.53:1;12 cases of AKII stage,25 cases of AKIII stage,and 189 cases of AKI stage Ⅲ,with mortality rates of 3.1%,6.6%,and 43.8%.Among 226 patients with AKI,there were 129 pre-renal AKI patients with a mortality rate of 31.4%.The main causes of septic shock and sepsis caused by various severe infections were 76 cases,followed by insufficient blood volume.Body fluid loss caused by trauma,surgery,major bleeding,etc.,a total of 32 cases,a total of 15 cases of cardiogenicity,the other 6 cases.There were 89 cases of renal AKI with a mortality rate of 20.4%,including 52 cases of drug influence,17 cases of contrast-related nephropathy,and 20 cases of other cases;8 cases of post-renal AKI,accounting for 3.6%,and the mortality rate was 1.7%,mainly malignant.Tumors affect the kidneys,followed by ureteral stones and prostate diseases.The ROC curve was used to compare the AKI stage and APACHE Ⅱ scores of patients with AKI in the ICU to predict the mortality of patients.The results suggest that the area under the curve of APACHE Ⅱ score and AKI stage for prognosis of patients is 0.698 and 0.650,respectively.The high predictive value was statistically significant(P=0.00),and the value of the APACHE Ⅱ score was higher than the AKI stage.Univariate analysis showed whether CRRT treatment,mechanical ventilation and vasoactive drugs,thrombocytopenia,hyperlactosis,APACHE Ⅱ score>25,MODS number≥3,hyperkalemia,hyperphosphatemia,There were significant differences in the prognosis between the two groups(P<0.05).There was no significant difference in the analysis of different patterns and start-up time compared with the prognosis of patients undergoing CRRT(P>0.05);multivariate logistic regression The results showed that hyperlactosis,MODS>3,mechanical ventilation,and vasoactive drugs were risk factors for prognosis in patients with AKI.The degree of influence was mechanical ventilation,vasoactive drugs,MODS>3,and hyperlactosis(The regression coefficients were-1.7497,-0.69,-0.489,-0.382.CRRT treatment can improve the prognosis of patients.Conclusions:1.The incidence of acute kidney injury in the ICU is still high,up to 22.5%,and the mortality rate is 53.5%.2.The cause of AKI patients in ICU is pre-renal,mainly septic shock and sepsis caused by severe infection,and the highest mortality rate.3.APACHE II score and AKI staging have high value in judging the prognosis of AKI patients in ICU.The predictive value of APACHE Ⅱ score is higher than AKI staging.4.CRRT can improve the prognosis of patients with AKI in ICU,but there is no statistically significant difference in prognosis,pattern and start-up time.5.Mechanical ventilation,use of vasoactive drugs,the number of MODS>3,lactate is a risk factor for prognosis in patients with acute kidney injury in ICU,the degree of influence is mechanical ventilation,the use of vasoactive drugs,the number of MODS≥ 3,hyperlactemia.