The Effects Of Coagulation Indexes On Prognosis In Patients With Septic Acute Kidney Injury

Objective: To observe the dynamic changes of coagulation indexes and to explore the relationship between coagulation function and poor prognosis of patients with septic acute kidney injury(AKI).Methods: A retrospective cohort study,single centered.Clinical data of septic AKI patients hospitalized in our hospital from June 2016 to June 2019 were collected.These patients were followed up for 28 days and the changes of coagulation indexes were recorded dynamically.According to the clinical outcomes,the septic AKI patients were divided into the death and the survival groups,and the survivors were divided into recovery and non-recovery groups depending on renal function.Differences in general clinical data between the death and the survival groups,the non-recovery and the recovery groups were compared.So as to explore the relationship between coagulation function and mortality or renal non-recovery in septic AKI.Results: A total of 3822 sepsis patients were found during the study period,and 348 septic AKI patients were eventually enrolled.The ratio of male to female was 2.22:1,with an average age of 58.74 ± 16.52 years.Clinical outcomes at 28 days: 78 dead,270 survived(140 with renal function non-recovery group and 130 with recovery group).The 28 days all-cause mortality rate was 22.41%,and the percentage of renal function non-recovery in the survivors was 51.85%.The primary infection foci were mainly pulmonary infection(194 cases,accounting for 55.75%),and gram-positive bacterial infection was the majority(203 cases,accounting for 58.33%).There were 196 patients(about 56.38%)due to prerenal disease,and the intensive care unit(ICU)occupancy rate was64.94%(226/348).65.8% of the septic AKI patients had at least one abnormal coagulation index(229/348).128 septic AKI patients developed multiple organ dysfunction syndrome(MODS)which accounting for 36.8%.The incidence of MODS,coagulation disorder and ICU admission rates,percentage of neutrophils,serum creatinine,mean prothrombin time(PT),mean activated partial thrombin time(APTT)and mean international normalized ratio(INR)in the death group were higher,while the mean arterial pressure,hemoglobin(Hb),serum albumin,serum uric acid(UA),blood calcium(Ca),mean platelet(PLT)count and mean fibrinogen were lower,compared with the survival group.The blood phosphorus,mean value of PT,APTT,INR and thrombin time in the non-recovery group were higher,while diastolic blood pressure(DBP),white blood cell count,Hb,serum UA,blood Ca and mean PLT count were lower,compared with the recovered group(P<0.05).Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of the thrombocytopenia group,PT prolonged group and APTT prolonged group was lower compared with non-thrombocytopenia group,non-PT prolonged group and non-APTT prolonged group(52.0% VS 81.6%,44.1% VS82.6%,41.2% VS 79.2%,P<0.05).Cox regression analysis indicated that MODS,Hb decreased,thrombocytopenia,PT prolonged and APTT prolonged had a higher risk of all-cause death in patients with septic AKI(HR=4.190,2.001,2.105,2.898,3.006).Logistic regression analysis indicated that the risk of renal function non-recovery in patients with septic AKI was higher in men,DBP decreased,Hb decreased,PT prolonged and APTT prolonged(OR=3.459,0.948,3.012,3.613,3.932,P<0.05).The area under the receiver operating characteristic curve(AUROC)for predicting mortality of patients with septic AKI by PLT count,PT,APTT and regression equation was 0.632,0.734,0.685 and 0.784,respectively.The AUROC for predicting renal function non-recovery of patients with septic AKI by PT,APTT and regression equation was 0.752,0.622 and 0.784,respectively(P<0.05).Conclusions: Patients with septic AKI had a low renal function recovery rate,high mortality and incidence of coagulation abnormalities.Thrombocytopenia,PT prolonged and APTT prolonged are important factors of poor prognosis in septic AKI.