Analysis Of The Characteristics And Related Risk Factors Of Acute Kidney Injury In Severe Patients

Objective: To explore the characteristics and related risk factors of Acute kidney injury(AKI)in patients with severe AKI,so as to provide a basis for better understanding of patients with severe AKI and improving their prognosis.Methods: The medical records of all critical patients admitted to the ICU of Rui Kang Hospital Affiliated of Guangxi University of Chinese Medicine from January 1,2020 to December 31,2020 were collected.According to the diagnostic criteria for Kidney Disease: Improving Global Outcomes(KDIGO)comes published in 2012,patients with complete medical histories of AKI were screened.The incidence,general condition and etiological distribution of AKI in severe patients were retrospectively analyzed.Logistic regression was used to analyze the risk factors affecting progression of severe AKI stage 1 to stage 2-3.Cox proportional risk regression model was used to analyze the risk factors affecting nosocomial death and renal prognosis in patients with severe AKI.Results: 1.Among the 1375 admitted patients,261 of the remaining 915 patients met the diagnostic criteria for AKI according to the exclusion criteria,with a morbidity and fatality rate of 28.52% and 40.23% for AKI.The male to female ratio of AKI patients was 2.26:1(181:80),and the median age was 68(53,78).The highest proportion of AKI patients was found in the 60-79 group(42.53%).2.Prerenal,renal and postrenal AKI accounted for 67.43%,30.65% and1.92%,respectively;Prerenal factors were the most common cause of severe AKI,among which sepsis was the most common(67.43%).3.Multivariate Logistic regression analysis suggested that the independent risk factors that promoted the progression of AKI patients from stage 1 to stage2-3: Age(compared with 18 to 39 years old group)60-79 age group(OR =1.67),at the age of 80 OR higher(OR = 1.54),acute cerebral infarction(OR= 1.98),chronic kidney disease(CKD)history(OR = 3.98),sepsis shock(OR= 4.67),the use of nephrotoxicity drugs(OR = 2.12),number of extra-renal organ failure,2 OR more(OR = 5.17),high bilirubin blood disease(OR = 1.23),low protein(OR = 1.32),oliguria(OR=2.18),low blood pressure(OR = 2.78)within 1 week before(P < 0.05).4.Multivariate Cox regression analysis showed that the independent risk factors for in-hospital death of patients with severe AKI were age(compared with 18-39 years old group)60-79 years old group(HR= 1.72)and ≥80 years old group(HR=2.02);AKI stage(compared with AKI stage 1)AKI stage 2(HR=1.66),AKI stage 3(HR =1.92);Acute myocardial infarction(HR =1.43);Septic shock(HR =2.42);The number of extrarenal organ failure≤2(HR=3.32);Hypoproteinemia(HR=1.34)(P(27)0.05).5.Multivariate Cox regression analysis showed that the independent risk factors for renal prognosis in patients with severe AKI were age(compared with 18-39 years old group)60-79 years old(HR =1.72)and ≥80 years old(HR=1.56);AKI stage(compared to AKI stage 1)AKI stage 2(HR =1.26),AKI stage 3(HR =1.75),acute myocardial infarction(HR =2.12),history of CKD(HR =2.47),septic shock(HR =1.56),number of extrarenal organ failure ≥2(HR =1.94)(P < 0.05).Conclusion: 1.AKI is a common clinical syndrome in severe patients with high morbidity and mortality.Elderly people are the high-risk group of AKI patients,and sepsis is the main cause of AKI in severe patients.2.Age,acute cerebral infarction,CKD,septic shock,use of nephrotoxic drugs,the number of extrarenal organ failure≤2,hyperbilirubinemia,oliguria,hypoproteinemia,and hypotension within the previous week are independent risk factors for progression of severe AKI from stage 1 to 2-3.3.Age,AKI stage,acute myocardial infarction,septic shock,the number of extrarenal organ failure ≥2,hypoproteinemia are independent risk factors for nosocomial death in patients with severe AKI.4.Age,AKI stage,acute myocardial infarction,history of CKD,septic shock,the number of extrarenal organ failure ≥2 are independent risk factors affecting renal prognosis of severe patients with AKI.