To Explore The Timing Of CRRT And Prognostic Factors In Patients With Septic Acute Kidney Injury

Objective:By analyzing clinical outcome indicators of patients with septic acute kidney injury(SAKI)receiving continuous renal replacement therapy(CRRT),the timing of CRRT application in patients with SAKI was discussed,and the prognostic factors of SAKI patients were analyzed.Methods:A retrospective analysis was made on 102 SAKI patients who received continuous renal replacement therapy in the intensive care unit(ICU)of the first Hospital of Shanxi Medical University from September 1,2018 to October 31,2020.The patients were divided into two groups according to the diagnostic criteria of sepsis 3.0 and the AKI staging criteria of Kidney Disease:Improving Global Outcomes(KDIGO)in 2012.One group is the early group(sepsis with AKI2 and CRRT)with 55 cases and the other is the late group(sepsis with AKI3 and CRRT or RRT absolute indication)with 47 cases.The sex,age,primary infection disease,total length of stay,length of stay of ICU,time of mechanical ventilation,treatment time of CRRT,mortality in hospital,recovery rate of renal function,APACHEII score,SOFA score,biochemical index were collected from the two groups,and the effects of different application time of CRRT on the prognosis were compared.According to the survival condition at discharge,the patients were divided into survival group and death group.The above indexes were compared and the factors affecting the prognosis of SAKI patients were analyzed.Results:1.Comparison of clinical data of SAKI patients before CRRT: there was no significant difference in age,sex,SOFA score,APACHE II score,p H,PCT,urine volume and primary infection site between the early and late groups(P > 0.05).There was significant difference in BUN、Scr,between the two groups(P<0.05).2.Comparison of the clinical outcome indexes between the early group and the late group: There was no significant difference in ICU length of stay,total length of stay,CRRT treatment time,mechanical ventilation time and use of booster drugs in early and late groups(P>0.05).The renal function recovery and hospitalization mortality of the two groups were statistically significant(P<0.05).The proportion of renal function recovery in the early group was higher than that in the late group,and the hospitalization mortality was lower than that in the late group(61.82% vs 36.17%;20.00% vs 57.45%).3.The factors affecting the prognosis of SAKI patients:(1)Compared with the deaths,In the survived group,low SOFA and APACHE II scores,low BUN and Scr,more urine,more net liquid output,the rate of recovery of renal function is high,the number of organ failure is less,and the proportion of booster drugs is low,the proportion of patients using CRRT early is high,the differences are statistically significant(P<0.05).(2)The above parameters are analyzed by two kinds logistic non-conditional regression analysis,age(OR=0.966,P<0.05),CRRT timing(OR=0.185,P<0.05),number of cases with organ failure(OR=0.431,P<0.05),APACHE II score(ORP<0.852,P<0.05)is an independent risk factor affecting the survival of SAKI patients;urine volume(OR=1.008,P<0.05),negative liquid equilibrium(OR=1.010,P<0.05)is an independent protective factor affecting the survival of SAKI patients.Conclusion:1.The early CRRT can reduce the hospitalization mortality of SAKI patients,but it has no obvious effect on the ICU hospitalization time and the total hospitalization time.2.Age,CRRT timing,number of complicated organ failure and APACHE II score are independent risk factors for SAKI patients’ survival;urine volume and negative liquid equilibrium are independent protective factors for patients’ survival.